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REVIEW OF
FALL SAFETY OF CHILDREN
BETWEEN THE AGES OF
18 MONTHS AND 4 YEARS
IN RELATION TO
GUARDS AND CLIMBING
IN THE BUILT ENVIRONMENT
Prepared for
National Ornamental & Miscellaneous
Metals Association
(NOMMA)
Prepared by
NAHB Research Center, Inc.
400 Prince Georges Boulevard
Upper Marlboro, MD 20774
December 2007
3270.001_20071204R20080506
WITH PEER REVIEW
MISSION STATEMENT
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improve the quality, durability, affordability, and environmental performance of homes and home
building products.
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Neither the NAHB Research Center, Inc., nor any person acting in its behalf, makes any
warranty, express or implied, with respect to the use of any information, apparatus, method, or
process disclosed in this publication or that such use may not infringe privately owned rights, or
assumes any liabilities with respect to the use of, or for damages resulting from the use of any
information, apparatus, method, or process disclosed in this publication, or is responsible for
statements made or opinions expressed by individual authors.
REVIEW OF
FALL SAFETY OF CHILDREN BETWEEN THE AGES 18 MONTHS
AND 4 YEARS IN RELATION TO GUARDS
AND
CLIMBING IN THE BUILT ENVIRONMENT
Alan Hedge, Ph.D.
Thomas Kenney, P.E.
Phillip Davis
December 4, 2007
3270.001_20071204R20080506
WITH PEER REVIEW
About the Authors
Alan Hedge, PhD, CPE, FHFES, FIEA, FErgS, is President of Humanuse Inc., an
independent Ergonomics Consulting company. He is also a Professor in the Department of
Design and Environmental Analysis, Cornell University and a Research Professor in the
Department of Biomedical and Chemical Engineering at Syracuse University. He joined
Cornell in 1987 and since then he has directed the Human Factors and Ergonomics teaching
and research programs and he also is co-director of the Design Concepts Laboratory in the
department. Prior to joining Cornell, for over 10 years he ran the Graduate Program in
Applied Psychology and Ergonomics at Aston University, Birmingham, U.K. He is a Fellow
of the U.S., U.K., and International Professional Ergonomics Societies and, in 2003 he
received the Human Factors and Ergonomics Society outstanding design award.
Thomas Kenney, P.E., is Vice President of Engineering and Research at the NAHB
Research Center. He is a licensed professional engineer in Florida and Maryland. His
multidisciplinary work on building codes and standards began in 1996 with the CABO Oneand Two-Family Dwelling Code and has continued through the development of the
International Code Council’s I-Codes. He oversees a group of engineering staff at the
NAHB Research Center that advises the National Association of Home Builders, builders
and remodelers on interpretation, application and development of code provisions.
Phillip Davis is a Senior Economist/Analyst at the NAHB Research Center with 20 years
experience in housing-related research. His expertise includes statistical and other
quantitative analysis, computer-based modeling, and database programming. His work has
included research related to housing construction/remodeling technology and techniques,
building code, safety, and durability issues, military housing and housing markets.
Disclaimer
Neither the NAHB Research Center, Inc., nor any person acting on its behalf, makes any
warranty, express or implied, with respect to the use of any information, apparatus, method,
or process disclosed in this publication or that such use may not infringe privately owned
rights, or assumes any liabilities with respect to the use of, or for damages resulting from the
use of, any information, apparatus, method, or process disclosed in this publication, or is
responsible for statements made or opinions expressed by individual authors.
Abstract
This paper provides a summary of the building code requirements, a critical review of
relevant peer-reviewed scientific literature on guard research and injury data related to
children’s climbing, and an analysis of the latest injury statistics. The paper focuses on
children between 18 months and 4 years of age as the most vulnerable population because of
their strength and climbing abilities. Three areas related to guards in residential settings are
examined: building codes, published research studies, and recent unpublished injury fall data.
Model building code requirements and terminology are summarized to provide context.
There is inconsistent use of terminology for guards, rails, barriers, balusters, etc., in the
building codes. Over 40 peer-review studies on children’s physical development, children’s
cognitive and social development relevant to climbing, and children’s falls from buildings
and structures are critically reviewed. Research shows that climbing plays an important role
in the physical, cognitive and social development of the young child, and that this is
encouraged in many situations, such as playgrounds and school gymnasia. Research studies
of injuries to children are medically oriented and seldom explore any guard design issues.
Studies of the climbability of different fencing designs use inconsistent terminology to
describe the designs tested, they use adult encouragement of children to climb the fences,
and they provide abundant padding to protect against a fall. Such contrived situations do not
reflect how behavior might occur in a naturalistic setting. Some of these studies also use
extremely small sample sizes which negates any statistical analysis of the data. Recent fall
injury data from the U.S. Consumer Product Safety Commission on accidents with guards
was analyzed. The results indicate that falls from these assemblies among young children
aged 18 months to 4 years account for an estimated 0.032 percent of injuries resulting in
emergency room visits in that population.
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Executive Summary
• The National Ornamental & Miscellaneous Metals Association (NOMMA)
commissioned this paper in response to a need for data to assist the Code Technology
Committee (CTC) of the International Code Council (ICC).
• “Guards” is a term-of-art used in ICC codes, standards, and life safety codes to describe a
means of fall protection that is required along open-sided walking surfaces; including
porches, decks, balconies, mezzanines, stairs, ramps, and landings that are located more
than 30 in (76.2 cm) above the floor or grade below.
• This paper provides a summary of the building code requirements for guards, a critical
review of relevant peer-reviewed scientific literature on guard research and injury data
related to children’s climbing, and an analysis of the latest injury statistics.
• The paper focuses on children between 18 months and 4 years of age as the most
vulnerable population because of their strength and climbing abilities.
• Model building code requirements and terminology are summarized to provide context.
There is inconsistent use of terminology for guards, rails, barriers, balusters, etc., by peerreview literature and in the National Electronic Injury Surveillance System (NEISS)
database of injuries. Building codes tend to be more constant but differences were noted
between countries.
• Building codes vary in the height above grade at which a guard is required, from 23.6 in
(60 cm) to 39.4 in (100 cm).
• Building codes vary in barrier height requirements between 36 in (91.4 cm) and 42 in
(107 cm).
• All building codes reviewed in this study agree that any aperture should be not larger than
a 4-in (10 cm) sphere, except for the Building Code of Australia which requires maximum
4.9 in (12.5 cm) sphere.
• The IRC implicitly differentiates between guards and barriers—guards defend against
accidental falls from elevated walkways, whereas barriers are intended to minimize
incidents of drowning by inhibiting motivation by placement of an imposing obstruction
between the child and the pool area.
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• Over 40 peer-review studies on children’s physical development, children’s cognitive and
social development relevant to climbing, and children’s falls from buildings and structures
are critical reviewed.
• Research shows that climbing plays an important role in the physical, cognitive, and social
development of the young child, and that this is encouraged in many situations, such as
playgrounds and school gymnasia.
• Research studies of injuries to children are medically oriented and seldom explore any
guard design issues. These studies extrapolate from smaller, longitudinal data sets, usually
within a hospital or particular location, to give a national estimate of injuries. Such
estimates typically are much larger than the percentage of injuries recorded in the latest
injury data set.
• Studies of the climbability of different fencing designs have used inconsistent terminology
to describe the designs tested, have used adult encouragement of children to climb the
fences, and also have provided abundant safety padding to protect against a fall. Such
contrived situations do not reflect how behavior might occur in a naturalistic setting.
• Some of the research studies on climbing fences also have used sample sizes that are
much too small for any statistical analysis of the data.
• No research study has yet investigated whether specific design elements can either entice
children to climb or discourage them from attempting to do so.
• From the research it is possible to identify some general design features that will make
climbing more difficult, and these include: barrier height (1 m [3.28 ft] plus); top rail that
is difficult to grasp, and not broad enough for a child to stand on; horizontal rails with
very close or very wide spacing; vertical rails; openings that are too small for stable
footholds; and steeply angled surfaces.
• Recent fall injury data from the U.S. Consumer Product Safety Commission on accidents
with guards is analyzed. The results indicate that climbing and falls from these assemblies
among young children aged 18 months to 4 years account for an estimated 0.032 percent
of injuries resulting in emergency room visits in that population.
• Results from either the research studies or the injury data are neither specific enough nor
consistent enough to constitute a solid basis for building code requirements.
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• Children’s safety concerning guards cannot be guaranteed solely by guard design, but
must also involve a program of education on when it is appropriate and when it is not
appropriate to engage in climbing a structure.
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Table of Contents
Abstract..............................................................................................................................................i
Executive Summary......................................................................................................................... iii
Table of Contents ........................................................................................................................... vii
Introduction ...................................................................................................................................... 1
Background...................................................................................................................................... 2
Building Codes ............................................................................................................................ 3
U.S. Codes.............................................................................................................................. 3
Canadian Codes ..................................................................................................................... 3
Australian Codes..................................................................................................................... 4
New Zealand Codes ............................................................................................................... 4
Terminology................................................................................................................................. 5
Guards .................................................................................................................................... 5
Barrier ..................................................................................................................................... 5
Ladder Effect........................................................................................................................... 6
Facilitate Climbing................................................................................................................... 6
U.S. Fall Injury Data .................................................................................................................... 6
Peer-Review Studies ....................................................................................................................... 8
Introduction.................................................................................................................................. 8
Children’s Physical Development................................................................................................ 8
U.S. Children’s Anthropometric Dimensions........................................................................... 8
Children’s Cognitive and Social Development Relevant to Climbing ................................... 12
Risk Taking in Children ......................................................................................................... 15
Children’s Climbing Skills...................................................................................................... 18
Children’s Interaction with the Built Environment...................................................................... 26
Ladders ................................................................................................................................. 26
Children’s Falls from Buildings and Structures ..................................................................... 28
Windows................................................................................................................................ 30
Stairs ..................................................................................................................................... 33
Playgrounds and Ladders ..................................................................................................... 36
Safety Barriers ...................................................................................................................... 38
Climbing from Children’s Cribs ............................................................................................. 38
Child Protective Fencing ....................................................................................................... 39
Fence Design: Australian Research ..................................................................................... 40
Fence Design: U.S. Research .............................................................................................. 41
Climbing Protocol and Success Measure ............................................................................. 42
Study 1 – Effects of Fence Design ....................................................................................... 43
Study 2 – Effects of Fence Design Modifications ................................................................. 44
Study 3 – Effects of fence height .......................................................................................... 48
Fence Design – Dutch Research.......................................................................................... 53
Fence Design – NZ Research .............................................................................................. 55
Swimming Pool Fencing ....................................................................................................... 58
Conclusions ................................................................................................................................... 61
References .................................................................................................................................... 64
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Appendices
Appendix A Excerpts of Provisions on Guards from National Model Building Codes.................. A-1
Appendix B National Electronic Injury Surveillance System (NEISS)
Data Set 2002 through 2005 Consumer Product Safety Commission ..................... B-1
Appendix C Peer Review..............................................................................................................C-1
List of Figures
Figure 1
Standing Center of Gravity for Boys Aged 2.5-4.5 Years ...........................................10
Figure 2
The Visual Cliff ............................................................................................................13
Figure 3
Determinants of Children’s Risk..................................................................................18
Figure 4
Gross Motor Development in Young Children ............................................................22
Figure 5
Hand Grip Strength Changes with Age.......................................................................23
Figure 6
Illustration of Ladder and Stairs ..................................................................................27
Figure 7
Ladder Rung Patterns.................................................................................................27
Figure 8
Three Different Strategies for Climbing a Stair Guard ................................................35
Figure 9
Model of the Stair Guard Climbing Decisions Process in Young Children .................36
Figure 10
Effects of First Rung Height on Ladder Climbing Success at Different Ages .............37
Figure 11
Typical Corner Climbing Pattern .................................................................................39
Figure 12
Typical Side Climbing Pattern.....................................................................................39
Figure 13
Climbing Success at Different Ages for Different Fence Designs .............................41
Figure 14
Example of Study 1 and Study 3 Apparatus ...............................................................42
Figure 15
Age and Design Effects on Climbing Success for a 48 in (122 cm) High Fence........45
Figure 16
Age and Design Effects on Climbing Speed for a 48 in (122 cm) High Fence ...........45
Figure 17
Example of Study 2 Apparatus ...................................................................................46
Figure 18
Age and Fence Design Effects on Climbing Success.................................................47
Figure 19
Age and Fence Design Effects on Climbing Speed....................................................48
Figure 20
Age and Fence Height Effects on Climbing Success .................................................51
Figure 21
Age and Fence Height Effects on Climbing Speed.....................................................52
Figure 22
Experimental Apparatus..............................................................................................54
Figure 23
Age and Height Effects on Climbing Success for the Rail Fence...............................54
Figure 24
Age and Fence Design Effects on Climbing Success at a 39.4 in (100 cm) Height...55
Figure 25
Typical Movement Pattern of a Child Climbing Over the Pool Wall............................59
Figure 26
Typical Movement Pattern of a Child Climbing Over the Pool Wall
with the Aid of the Pool Filter ......................................................................................59
Figure 27
Typical Movement Pattern of a Child Climbing Over the Pool Wall
with the Aid of the Safety Ladder Frame ....................................................................60
Figure 28
Some Factors that Influence a Child’s Climbing Ability ..............................................61
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List of Tables
Table 1
Comparison of Codes Requirements for Balcony Guards............................................5
Table 2
Anthropometric Data of Children Aged 2 to 4.5 ..........................................................11
Table 3
Stature Data of Children Aged 2 to 4 Years ...............................................................12
Table 4
Development of Climbing Skills through Age 6...........................................................20
Table 5
Hand Grip Strength Changes with Gender and Age...................................................24
Table 6
Age Differences in Ladder Climbing Grips..................................................................24
Table 7
Characteristics of Good and Bad Climbers.................................................................25
Table 8
Examples of Objects that a Child will Climb at Different Ages ...................................26
Table 9
Barrier Designs and Test Results ...............................................................................56
Table 10
Some Design Details that Affect the Ease of Climbing a Barrier................................63
Table B 1
Tabulations on NEISS Records 2002 - 2005............................................................ B-2
Table B 2
Weighted National Estimates Based on Tabulations
of NEISS Records 2002 - 2005................................................................................. B-3
Table B 3
Number of Records Found in NEISS Data Years 2002 through 2005
for Incidents Involving Patients 18 Months through 4 Years of Age ......................... B-3
Table B 4
Railing or Rail Related Records................................................................................ B-5
Table B 5
Breakdown of 61 Records, Corresponding Estimates and Annual Averages .......... B-7
Table B 6
Case Numbers of 312 Rail or Railing Related Incident
Records in NEISS Tabulation ................................................................................. B-11
Table B 7
Case Number of 61 Railing or Rail Related
Records Involving a Fall, Jump, Slip from a Rail, or Railing................................... B-14
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Introduction
The National Ornamental & Miscellaneous Metals Association 1 (NOMMA) commissioned
this paper in response to a need for data to assist the Code Technology Committee (CTC) of
the International Code Council 2 (ICC). At the request of the ICC Board of Directors in May
2004, the CTC embarked on a data gathering and review process to assess safety of children
in relation to guards. “Guards” is a term-of-art used in ICC codes, standards, and life safety
codes to describe a means of fall protection that is required along open-sided walking
surfaces; including porches, decks, balconies, mezzanines, stairs, ramps, and landings that are
located more than 30 in (76.2 cm) above the floor or grade below.
This paper provides a critical review of relevant peer-reviewed scientific literature on guard
research and injury data. The paper was assembled to inform and assist the CTC in the
debate about safety of guards for children between the ages 18 months and 4 years. The
scope of this paper is inclusive of all known research conducted in the United States and
internationally on the topics of climbing, safety, and fall prevention relating to children’s
physical and mental capabilities. Hospital reported injury data for the United States for years
2002 through 2005 was also examined to assess the incidence rates of fall-related injuries of
children in residential settings.
The scope and objectives of CTC’s study are summarized below to provide context for the
range of issues discussed in this paper. The stated scope of the CTC’s study of guards is to
determine the need for appropriate measures to prevent or inhibit an individual from
utilizing the elements of a guard system including rails, balusters, and ornamental patterns to
climb the guard, thereby subjecting that person to the falling hazard which the guard system
is intended to prevent. The objective of the CTC investigation includes a determination of
the parameters necessary in order to achieve code requirements for providing necessary and
reasonable protection against the climbing of guards. These parameters include, but are not
limited to:
1. Review code development history.
2. Demographics of persons to be protected.
1
The National Ornamental & Miscellaneous Metals Association located in McDonough, GA was formed in
1958 and now serves over 1,000 members across the United States and in over a dozen foreign countries.
NOMMA members produce metalwork ranging from railings to driveway gates, and from sculpture to light
structural steel.
2
The International Code Council, headquarters located in Washington, D.C., is a membership association
dedicated to building safety and fire prevention, develops the codes used to construct residential and
commercial buildings, including homes and schools. Most U.S. cities, counties and states that adopt codes
choose the International Codes developed by the International Code Council.
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3. Identify occupancies where protection is required.
4. Acquire and review statistical injury data relating to the scope of the study.
5. Identify patterns or arrangements of guard elements which implement or prohibit
climbing by those meeting demographics.
6. Develop code requirements which are responsive to identified public safety needs
while providing reasonable latitude for the design and construction of alternative
guard systems.
7. Develop an impact statement concerning the probable reduction of deaths and
injuries resulting from a code requirement.
Background
This study was undertaken to glean facts and findings from relevant peer-review research to
assess the performance of guards in relation to children climbing guards and injury from
subsequent falling over guards. Research studies reporting an analysis of injuries typically do
not systematically differentiate between those resulting from climbing over guards versus
those from falling through guards. Incidents in residential settings such as porches, decks,
balconies, clerestory spaces, windows, cribs, swimming pool barriers, and stairs are included
in the study. The scope of this study is limited to children between 18 months and 4 years of
age. This age bracket is the most vulnerable population of all children because strength and
climbing ability of children younger than 18 months is insufficient for guards to pose a
climbing hazard; and children above the age of 4 were deemed to have sufficient climbing
and cognitive capabilities such that nearly any barrier design can be defeated.
This study examines three areas related to guards in residential settings. Model building code
requirements and terminology are summarized to provide context. Terminology used for
guards, rails, barriers, balusters, etc., in the building codes and by researchers are not
uniformly applied. The reader needs to be aware of the usage differences to avoid
misinterpretation of discussions and findings. Recent fall injury data from the U.S.
Consumer Product Safety Commission was examined to assess data quality and its
applicability to assigning causality to accidents with guards. And, a critical review of over 40
peer-review studies extracted relevant information on children’s physical development,
children’s cognitive and social development relevant to climbing, and children’s falls from
buildings and structures.
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Building Codes
In the United States, the International Code Council (ICC) oversees the development of the
I-Codes; which is a multi-volume set of comprehensive documents that are updated annually
with interim amendments and new editions published on a three-year cycle. Germane to this
study is the International Residential Code (IRC). In order to understand the evolution of
the IRC, a review of predecessor regional codes to the IRC was undertaken in regard to the
specifications for guards. Excerpts from model codes dating back to 1990 are summarized in
Appendix A for historical context. Included in the Appendix are provisions from the
Canadian, Australian, and New Zealand building codes.
U.S. Codes
The IRC 2006 Edition requires a (36 in [91.44 cm] minimum height) guard on open sides of
porches, balconies, ramps, or raised floor surfaces that are located more than 30 in (76.2 cm)
above the floor or grade below. Guards are required to have intermediate rails or ornamental
closures that do not allow passage of a sphere 4 in (10 cm) or larger in diameter.
The IRC 2000 Edition, International One- and Two-Family Dwelling Code 1998 Edition,
and BOCA National Building Code 1998 Edition had an additional requirement prohibiting
the design and construction of guards such that, “horizontal rails or other ornamental
pattern results in a ladder effect.” The codes did not provide guidance, specification or
definition of “ladder effect.” Subsequent editions beginning with IRC 2003 Edition does not
have the term “ladder effect” as a criterion for barriers.
Canadian Codes
The National Building Code of Canada (NRC-NBC 2005) requires a (42 in [106.68 cm]
minimum height) guard on open sides of porches, balconies, ramps, or raised floor surfaces
that are located more than 23.6 in (59.94 cm) above the floor or grade below. Guards are
required to have intermediate rails or ornamental closures that do not allow passage of a
sphere 4 in (10 cm) or larger in diameter.
The Canadian building code first included a provision for limiting climbability in the 1975
model code, that ultimately became the current provision, “Unless it can be shown that the
location and size of openings do not present a hazard, a guard shall be designed so that no
member, attachment or opening located between 5.5 in (13.97 cm) and 35.4 in (89.92 cm)
above the level being protected by the guard will facilitate climbing.”
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Over the past several code cycles, mainly 1995-2005, provisions have been added to help
explain the terminology “facilitate climbing.” The following prescriptive provisions are
deemed to meet the intent of the code to limit climbability:
• Elements protruding from the vertical and located within the area between 5.5 in
(13.97 cm) and 35.4 in (89.92 cm) above the floor or walking surface protected by the
guard are located more than 18 in (45.72 cm) horizontally and vertically from each other;
• provide not more than 0.6 in horizontal offset; and
• do not provide a toe-space more than 1.8 in (4.57 cm) horizontally and 0.8 in (2.03 cm)
vertically, or present more than a 1-in-2 slope on the offset.
Australian Codes
Balustrades or other barrier construction are required for floors more than 39.4 in (100 cm)
above the surface beneath. When the elevation difference is 13.1 ft (400 cm) any horizontal
elements within the balustrade or other barrier between 6 in (15.24 cm) and 30 in (76.20 cm)
above the floor must not facilitate climbing.
New Zealand Codes
The New Zealand Building Code 2007 Edition requires a (39.37 in [100 cm] minimum
height) barrier on open sides of balconies and decks, and edges of internal floors or
mezzanine floors that are located more than 39.4 in (100 cm) above the floor or grade
below. Barriers are required to have intermediate rails or ornamental closures that do not
allow passage of a sphere 3.94 in (100 cm) or larger in diameter.
The New Zealand Building Code is a performance-based code and it provides prescriptive
designs in the Acceptable Solutions section of the code document. While climbability is not
specifically mentioned, interpretive comments in the Acceptable Solution section on barriers
explicitly address the intention to prevent most children up to the age of 3 from climbing
barriers. Also noted is the difficulty children have with climbing barriers with full-height
vertical members. Horizontal or near horizontal rails can easily be climbed by 2-year-olds if
the rails extend the full height of a barrier, even if the barrier includes a 7.87 in (20 cm)-wide
top rail or if it slopes inwards at 15°. Illustrations of barrier designs (see sample illustrations
in Appendix A) are provided in the Acceptable Solutions section for guidance and they are
treaded as deemed to comply.
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Table 1
Comparison of Codes Requirements for Balcony Guards
Code
IRC 2006
NRC-NBC 2005
Australian 2007
New Zealand 2007
Requirement
> 30 in
(76.2 cm)
of grade
> 23.6 in
(60 cm)
Min.
Height
36 in
(91.4 cm)
Max.
Aperture
4 in
(10 cm)
sphere
4 in
(10 cm)
sphere
42 in
(108.7 cm)
> 13.1 ft
(400 cm)
> 39.4 in
(100 cm)
39.4 in
(100 cm)
> 39.4 in
(100 cm)
39.4 in
(100 cm)
4.9 in
(12.5 cm)
sphere
4 in
(10 cm)
sphere
Climbing
no member, attachment or opening
located between 5.5 in (3.97 cm)
and 35.4 in (89.92 cm) above the
level being protected by the guard
will facilitate climbing
any horizontal elements within the
balustrade or other barrier between
6 in (15.24 cm) and 30 in (76.2 cm)
above the floor must not facilitate
climbing
balustrades and barriers are
required
Terminology
Guards
“Guards” is a term-of-art used in ICC codes, standards, and life safety codes to describe a
means of fall protection that is required along open-sided walking surfaces; including
porches, decks, balconies, mezzanines, stairs, ramps, and landings that are located more than
30 in (76.2 cm) above the floor or grade below. Guards are defined as “A building
component or a system of building components located near the open sides of elevated
walking surfaces that minimizes the possibility of a fall from the walking surface to the lower
level.”
Barrier
The term “barrier” is used in the International Residential Code in Appendix A to define a
physical obstruction to provide protection against potential drowning by restricting access by
children to swimming pools, spas, and hot tubs. The term “barrier” does not appear in the
definitions section of the IRC. Barriers are required to be 48 in (121.9 cm) above the walk
surface, whereas guards are required to be 36 in (91.4 cm) above the walk surface. The IRC
implicitly differentiates between guards and barriers—guards defend against accidental falls
whereas barriers are intended to inhibit motivation by placement of an imposing obstruction
between the child and the pool area.
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The New Zealand building code does not use the term “guard,” but consistently uses the
term “barrier” for pool areas and for open sides of elevated walking surfaces to minimize the
possibility of a fall from the walking surface to a lower level. Researchers of peer-review
literature in this also use the term “fencing” which is synonymous.
Ladder Effect
In EN-1176-1 (1998) a ladder is defined as “the primary means of access incorporating
rungs or steps on which a user can ascend or descend.” The term “Ladder Effect” has been
used in building codes of the past, although it was not defined and it no longer appears in
current model building codes from Australia, Canada, New Zealand and the United States.
Facilitate Climbing
“Facilitate Climbing” is a term found in building codes to ascribe an attribute that is vague
and undefined. Secretariats of model building codes have struggled with providing guidance
to assist with enforcement of provisions that require guards to be of a design that does not
facilitate climbing. Prescriptive recommendations in code commentary documents and
professional judgment by designers are often relied upon to demonstrate compliance.
U.S. Fall Injury Data
One method of assessing safety performance of guards and children’s risky behavior is by
assessing actual injuries. Hospital injury records are commonly used as a metric by
researchers and child safety advocates to characterize the relative risk to other hazards. High
risk populations and deficient designs reveal themselves as relatively high incident rates of
injuries. The basis for this analysis is a database collected and managed by the U.S. Federal
Government through the Consumer Product Safety Commission (CPSC). The CPSC
maintains the National Electronic Injury Surveillance System (NEISS), which is a database
system of consumer product-related injuries—including accidents such as falls that occur in
dwellings. The NEISS data is available electronically through the Internet and consists of
information provided by a sample of hospital emergency departments in the United States
and its territories. Injury records are coded such that they may be screened by age, gender,
trauma type, disposition, and product type involved in the accident. Two notes fields provide
supplemental information about the injury or physical situation; however, the terminology
often used in these fields is undefined and is occasionally helpful and sometimes ambiguous.
This was the case when screening the records explicitly for injuries related to falls caused by
climbing a guard.
The NEISS data analyzed and reported in Appendix B indicated that relatively few injuries—
0.032 percent of all incidents resulting in emergency room visits involving children between
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the ages of 18 months and 4 years occurred from jumps, falls, or slips from a rail or railing in
a home, a daycare setting or an unknown setting. Injuries associated with falling through a
guard, falling against or use of adjacent objects to climb over were excluded from the injury
data set because the focus of this analysis was climbing and falling over the guard. These
records extrapolated to a national estimate of 354 incidents annually. The 1,421,137 injuries
reported by NEISS between 2002 and 2005, inclusive, correspond to a national estimate of
51,217,603 based on weighting data included with the record data. The average over the four
years is 12,804,401. The weighted estimate of 1,117,278 incidents on average annually for
children between the ages of 18 months and 4 years represents about 8.7 percent of these
incidents. For all the incidents to children between the ages of 18 months and 4 years, 5.6
percent involved stairs, 1.22 percent involved windows, and 0.87 percent involved porches,
balconies, open-sided floors, and floor openings.
The notes fields for 2,222 records with product codes for porches, balconies, open-sided
floors, and floor openings or handrails, railings, or banisters for patients between the ages of
18 months and 4 years were examined to identify obvious non-climbing and non-residential
guard-related accidents. When non-climbing and non-residential accidents were culled, the
incidence rate associated with jumps, falls, slips from rail or railing was 61 records. The
weighted national estimate of incidents corresponding to these records is 1,415 (or 354
annually or 2.5 per 100,000 3). This number represents 0.032 percent of all injuries to children
between the ages of 18 months and 4 years resulting in emergency room visits.
Caution should be used in applying the NEISS data to assign causation of an event. The
designations provided in the NEISS reporting system focus on “product codes” and not on
the mechanism or physical environment surrounding the injury. Two notes fields are
provided in the survey instrument for hospital administrators’ interpretation and annotation
of the event. The fields may be left blank and the terminology used in this section is
unstructured and left to the administrators’ discretion. The ability to isolate specific details is
a significant factor in understanding the mechanism of the type of incident being reported
and the current instrument is not optimal for the purpose of assessing with precision the
incidence of injuries associated with climbing and falling incidents. One possible
enhancement to the NEISS system would be the addition of codes that would identify the
precipitating action of an injury-producing incident such as “climbing” or “climbed the
guard and fell over” or “climbed on adjacent object and fell over” or “did not observe” or
“fell through or under the guard.” Another potential approach is to petition the CPSC to
conduct a follow-up investigation to develop more information relating to causality.
3
Based on an average population between 2002 and 2006 of children that are 18 months to 4 years of age
inclusive - 14,160,000 children.
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Peer-Review Studies
Introduction
Climbing is a natural childhood activity and plays a significant role in the emergence of
coordinated and symmetrical motor skills. Climbing is an integral part of young children’s
play. Many play structures are available in public, educational, and private settings to
encourage young children to practice and take pleasure in their climbing skills. Climbing is
integral to the physical, mental, and social development of the child. Climbing also
contributes to the incidental learning that occurs through play.
Understanding children’s motivation to climb, their perception of hazards, as well as other
social and physical factors in their environment that can facilitate climbing is essential to
designing barriers that discourage climbing and to protect children as far as is practicable.
Design and style can improve the aesthetic appearance of the environment but they should
never precede safety concerns.
This report reviews published literature on studies of the climbing skills of young children,
on injuries that occur when children accidentally fall, and on the design of protective barriers
that aim to discourage children’s climbing. It focuses on publications in peer-review journals
and on those studies of young children mostly through around 4 years of age. The focus of
the review is to determine the characteristics of what might constitute a child-proof barrier.
The report does not focus on design guidelines, code requirements, magazine and newspaper
articles, or other media coverage of relevant issues.
Children’s Physical Development
U.S. Children’s Anthropometric Dimensions
Information on the physical dimensions of children serves as a fundamental basis for
understanding the physical development of children and for obtaining information that can
be applied to the design of any protective barrier that will be capable of preventing a young
child from accidentally falling over or through the barrier. The composition of the U.S.
population is diverse and anthropometric data for the current population of U.S. children is
not publicly available; however, there is some data on relevant dimensions from previous
studies. The following physical dimensions are relevant to the design of a successful
protective barrier for young children.
• Standing Center of Gravity – when the center of gravity of a standing child is higher than
the height of a barrier then it is possible for the child to lose his or her balance and topple
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over the barrier. Consequently the height of the barrier should exceed the height of the
center of gravity of the standing child. For a 4.5-year-old child this means that the barrier
should be greater than 25.2 in (64 cm) high (see Figure 1).
• Head breadth – the breadth of the head (side-to-side) is smaller than the length of the
head (front-to-back) and this dimension is used as a guide to prevent entrapment of the
head. Here the important dimension is the smallest head size of the youngest child. For a
2-year-old child this means that the size of any aperture in a barrier should be less than
4.7 in (12 cm).
• Foot breadth – the ability to place the whole foot on a support will assist in climbing. The
dimensions shown are for a bare foot. Here the important dimension is the smallest foot
width of the youngest child. For a 2-year-old child this means that the size of any aperture
in a barrier should be less than 2 in (5.3 cm). Climbing may be facilitated if the young
child is able to get a toehold rather than a foothold. For a 3-year-old child the toe area of
a shoe that is sufficient to aid climbing has a depth of around 1.5 in (3.8 cm) and any
protrusion of 3/16 in (~50 mm) may be sufficient to allow a toehold (Stephenson, 1999).
• Step height – the ability of a child to climb a barrier will be affected by the step height
distance between footholds. If the maximum step height distance for the oldest child is
exceeded then climbing will be more difficult and less comfortable. For a 4.5-year-old
child the maximum vertical height between surfaces on which a child could put their foot
to use it as a step should exceed 21.9 in (55.5 cm).
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Figure 1
Standing Center of Gravity for Boys Aged 2.5-4.5 Years
(based on Snyder, R.G., Schenider, L.W., Owings, C.L.,
Reynolds, H.M., Golomb, D.H. and M.A. Schork, 1977)
2.5-3.5 yrs
CG 22.2"
3.5-4.5 yrs
CG 23"
• Stature – the height of the child affects the vertical reach distance for children to be able
to grasp the top of a barrier to use their arms to assist in climbing.
• Vertical grip reach – the vertical distance from the floor to a comfortable hand grip
affects the child’s climbing ability. If the height of the barrier exceeds this distance then
the child will not be able to reach to the top of the barrier without some type of aid
(jump, object to step on, etc.). Here the important dimension is the greatest vertical reach
grip distance of the oldest child. For a 4.5-year-old child this means that the height of a
barrier should be more than 53.5 in (136 cm).
Table 2 summarizes the minimum, 5th percentile, mean (50th percentile), 95th percentile, and
maximum dimensions of children aged 2 to 4.5 years that are relevant to barrier design.
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Table 2
Anthropometric Data (Dimensions Are in Inches: Centimeters) of Children Aged 2 to 4.5
(based on Snyder, R.G., Schenider, L.W., Owings, C.L.,
Reynolds, H.M., Golomb, D.H. and M.A. Schork, 1977)
Dimension
Standing Center of Gravity
Head breadth (smaller than
head length)
Foot breadth
Step height
Stature
Vertical grip reach
2 – 3.5 yrs
Percentile
50th
Max
Min
5th
50th
95th
Max
Min
5th
50th
95th
Max
Min
5th
50th
95th
Max
Min
5th
50th
95th
Max
Min
5th
50th
95th
Max
M
22.2
24.0
4.7
5.0
5.3
5.7
5.9
2.0
2.2
2.4
2.8
2.8
8.7
8.7
12.8
16.6
17.0
32.0
34.3
37.1
40.2
42.7
38.1
38.2
41.7
48.1
48.9
3.5 – 4.5 yrs
F
(56.3)
(61.0)
(12.0)
(12.7)
(13.5)
(14.7)
(15.0)
(5.3)
(5.5)
(6.2)
(7.0)
(7.2)
(22.1)
(22.2)
(32.4)
(42.1)
(43.2)
(81.3)
(87.0)
(94.3)
(102.2)
(108.5)
(96.8)
(97.1)
(105.8)
(122.2)
(124.3)
21.9
24.1
4.7
4.9
5.2
5.5
5.9
2.2
2.3
2.3
2.8
3.1
9.1
9.3
12.8
18.4
18.5
33.0
33.5
36.2
39.1
41.7
38.4
38.7
41.6
45.6
49.1
M
(55.5)
(61.2)
(11.9)
(12.5)
(13.2)
(13.9)
(14.9)
(5.0)
(5.2)
(5.9)
(6.6)
(7.9)
(23.2)
(23.7)
(32.6)
(46.7)
(47.1)
(83.8)
(85.1)
(92.0)
(99.4)
(105.9)
(97.5)
(98.2)
(105.6)
(115.9)
(124.6)
23.0
24.9
5.0
5.1
5.4
5.7
7.0
2.2
2.3
2.5
2.8
3.1
10.6
12.0
15.7
19.6
21.9
35.8
36.9
39.7
42.9
44.6
41.1
41.5
45.1
50.3
53.5
F
(58.4)
(63.3)
(12.8)
(13.0)
(13.7)
(14.7)
(17.9)
(5.5)
(5.8)
(6.4)
(7.2)
(7.8)
(26.9)
(30.4)
(39.4)
(49.7)
(55.5)
(90.9)
(93.8)
(100.8)
(109.0)
(113.3)
(104.4)
(105.5)
(114.5)
(127.8)
(136.0)
23.6
25.2
4.9
5.0
5.3
5.7
5.9
2.2
2.2
2.5
2.8
2.9
12.0
12.2
15.0
20.8
21.3
35.9
37.0
40.0
42.8
44.9
42.8
42.9
46.5
50.2
51.0
(60.0)
(64.0)
(12.4)
(12.6)
(13.5)
(14.4)
(15.0)
(5.7)
(5.7)
(6.4)
(7.1)
(7.4)
(30.5)
(31.0)
(38.0)
(52.8)
(54.1)
(91.1)
(93.9)
(101.7)
(108.7)
(114.1)
(108.6)
(108.9)
(118.1)
(127.6)
(129.5)
NOTE: the data are those currently publicly available for U.S. children and they are published in
the Final report Anthropometry of Infants, Children and Youths to Age 18 years for Product Safety
Design, report UM-HSRI-77-17 prepared for the U.S. Consumer Product Safety Commission by
The Highway Safety Research Institute, The University of Michigan, May 31, 1977. Note that
since this time the anthropometric dimensions of U.S. children may have increased, which means
that any design that satisfies the above will work for current child sizes.
Some updated data on children’s anthropometrics was published in the winter of 2002.
Table 3 summarizes this anthropometric data for the 10th, 50th and 90th percentiles for the
stature of male and female children aged 2, 3, and 4 years.
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Table 3
Stature Data of Children Aged 2 to 4 Years
(McDowell, M.A., Fryar, C.D., Hirsch, R. and C. L. Ogden, 2005)
2 yrs
Percentile
Stature
(inches)
Stature
(centimeters)
3 yrs
4 yrs
M
F
M
F
M
F
10th
33.4
33.4
36.4
36.4
39.6
39.5
50th
35.8
35.3
38.9
38.6
41.9
41.6
90th
38.4
37.5
40.9
40.2
44.1
44.0
10th
84.7
84.9
92.5
92.6
100.7
100.3
50th
91.0
89.7
98.8
98.1
106.5
105.8
90th
97.6
95.3
103.9
102.2
112.1
111.7
NOTE: the data are those currently publicly available for U.S. children and they are published
McDowell, M.A., Fryar, C.D., Hirsch, R. and C. L. Ogden (2005) Anthropometric Reference Data
for Children and Adults: U.S. Population, 1999–2002, Advance DATA FROM Vital and Health,
Statistics, 361, July 7, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for
Disease Control and Prevention National Center for Health Statistics. Note that since this time the
anthropometric dimensions of U.S. children may have increased, which means that any design
that satisfies the above will work for current child sizes.
Since the 1977 survey the average height of young children has slightly increased. In 1977
the stature of an average 2-3.5-year-old boy was 37.1 in (94.3 cm) and in 2002 it was 37.4 in
(94.8 cm), and the stature of an average 2-3.5-year-old girl was 36.2 in (92 cm) and in 2002 it
was 37 in (93.9 cm). In 1977 the stature of an average 3.5-4.5-year-old boy was 39.7 in
(100.8 cm) and in 2002 it was 41.9 in (106.5 cm), and the stature of an average 3.5-4.5-yearold girl was 40.0 in (101.7 cm) and in 2002 it was 41.6 in (105.8 cm).
Children’s Cognitive and Social Development Relevant to Climbing
Understanding children’s cognitive development is important to designing barriers and
structures suitable for their safety. Even when children have the physical skills and strength
to be good climbers, their desire to climb will be influenced by their personality and
attitudes. Children who are somewhat apprehensive and afraid of new situations usually are
less likely to climb and spend less time climbing than children who are less fearful. Also,
experiencing a fear of heights is a very strong factor inhibiting children from climbing even if
they have the physical requirements.
The developing infant displays depth perception skills by the time they are able to crawl and
this is critical to their survival ability and may be innate. This ability was first demonstrated
in the famous “visual cliff” experiment conducted by Gibson and Walk (1960), who
demonstrated that infants old enough to crawl can perceive and avoid a “visual cliff” (see
Figure 2) so they can avoid drop-offs such as stairwells and edges of tables.
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Figure 2
The Visual Cliff
Even when encouraged,
an infant refuses to
cross a transparent
sheet because, even
though he can feel a
solid surface visually
there appears to be a
steep drop. This
demonstrates the “visual
cliff” phenomenon.
(Image source:
http://www.cofc.edu/
~psycadvise/images/Visual%2
0cliff.JPG)
The visual cliff consists of a covered platform and a piece of glass or other clear material
placed on this that extends well off of the platform, creating a sort of bridge. An infant is
placed on the platform, and the infant’s mother stands on the opposite side of the clear
bridge and encourages the child to crawl off the platform and onto the clear bridge. Very
young infants will do this indicating that they have not yet developed depth perception.
Older infants with depth perception will stop when they reach the edge of the platform
because as they look down at the “cliff” they aren’t yet at the developmental level to know
that the clear cover forms a bridge. By the time a child is able to climb stairs and structures
s/he will have well developed depth perception. Although babies aged 6-10 months show a
fear of changes in floor level, the visual cliff, and although young children may show some
reluctance to climb because of their height above the ground, the development of a true fear
of heights doesn’t appear until around the age of 9 or 10, which is the age when climbing
activities begin to decrease in frequency. At some point, however, and often as the result of
parental encouragement or peer pressure, or some other “reward or “incentive,” even at this
young age range most children will be curious enough to overcome their fear and attempt to
climb an object that they perceive as potentially hazardous when urged to do so.
Numerous factors affect the cognitive development of the child. One of the earliest
investigators of the cognitive development of young children was Jean Piaget, a Swiss
psychologist, who provided a very comprehensive theory spanning the period from birth to
the end of adolescence. Piaget’s theory encompasses the development of cognitive
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processes, including memory, causality, imitation, and logic and he authored numerous
books on the topic. His theory emphasizes the organization of a child’s knowledge rather
than the processes for the acquisition and application of the information (Small, 1990).
Piaget emphasized the biological functions of adaptation and organization as main
contributors of the development of cognitive structure. Adaptation has two component
functions: accommodation and assimilation. He proposed that all thoughts and actions
involve these two processes. Assimilation connects current information and experiences to
already existing knowledge or behavior. This results in the establishment of schemes for
actions and thoughts. For example, an infant develops an early scheme for clambering onto a
sofa and when presented with stairs for the first time will attempt to climb this in a similar
manner. After trial and error, infants learn to adjust their climbing technique to different
situations. Accommodation refers to this process of refinement and modification of an
existing scheme through experiences with different objects or events. In Piaget’s theory the
constant interaction of accommodation and assimilation together promote the development
of cognitive structures and facilitate the emergence of cognitive organization.
Children’s ability to perceive hazards and assess risks also is age and intellectual ability
dependent. Piaget’s theory proposes four periods of cognitive development:
• Sensorimotor period (0-2 years) – in this stage the child learns to differentiate himself
from objects, recognizes himself as an agent of action and begins to act intentionally.
Cognitively the child attains object permanence, i.e., they realize that things continue
to exist even when no longer in view. The child’s thinking is egocentric.
• Preoperational period (2-7 years) – The child uses language and to represent objects by
words and draws images of objects and words. The child’s thinking is still egocentric.
The child learns to classify objects by a single feature.
• Concrete operational period (7-11 years) – The child can think logically about objects
and events. They achieve conservation of number (age 6), mass (age 7), and weight
(age 9). They classify objects according to several features and can order them in series
along a single dimension such as size.
• Formal operations (11-15 years) – The child can think logically about abstract
propositions, test hypotheses about the world systemically, and become concerned
with the hypothetical, the future, and ideological problems.
A framework for understanding cognitive development embraces the tenets of an
information-processing approach to cognition, and this focuses on those processes that
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function to extract information from environmental stimuli (McShane, 1991). According to
this framework all humans process environmental information in a series of timely stages,
information is transformed during the processing stages, and there is a limited capacity to the
amount of processing that occurs at one time. The information-processing model comprises
a series of functional components: a sensory register, short-term memory, long-term
memory, a central processor, and a response system, and short-term sensory memories,
working and long term memories arise from different stages in the flow of information
through the sensory system (Small, 1990; Sanders & McCormick, 1993). As information is
processed decisions are made and usually these are output by a response system that controls
verbal and physical actions. From this framework young children are immature information
processors. They often do not have organized perceptual schema to understand situations,
they frequently cannot identify patterns (e.g., an inability to read), they have a poor memory
system, their reactions times are slow, and they lack the ability to execute coordinated
movements in a skilled manner. However, with maturity all these processes ultimately
develop to some degree of sophistication.
In addition to the stage of cognitive development, whether or not a child chooses to climb a
structure depends on other factors such as their level of motivation. Children often engage
in behaviors that are intrinsically motivating (Flavell,1977) and thus they will climb a
structure because they find it fun and enjoyable, because they are positioned on the top of a
structure that is higher than their peers and because they like to be able to show-off their
climbing prowess to others. Childhood games, such as “King of the Castle” further reinforce
the social desirability to climb to the top of a structure. Climbing games also provide
informal teaching experiences for the young child and they play an important role in their
social and motor development (Wood, 1998).
Risk Taking in Children
Children’s reactions to hazardous situations arise from a combination of factors that include
(a) direct exposure to the hazard combined with the perception of increased physical risk,
(b) pre-existing characteristics (e.g., age, gender, ethnicity, emotional maturity), (c) availability
of adaptive coping resources, (d) access to social support, (e) the occurrence of major life
stressors (e.g., injury or death of family or friends) following the hazard. Unfortunately, there
is a dearth of research-based literature on young children’s perception of hazards, especially
in relation to climbing and falls.
Unintentional injuries can arise as a result of a child misjudging the risks in a situation.
Young children show only a rudimentary sense of time and space and they lack a welldeveloped awareness of cause and effect associations (Ault, 1977) and this contributes to
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their risk-taking behaviors. Numerous factors exert an influence on children’s risk-taking
behaviors and these have been systematically reviewed (Morrongiello and Lasenby-Lessard,
2007) and an integrative model of the determinants of children’s risk decision has been
formulated (Figure 2). This model proposes that children’s risk taking is a multi-determined
outcome, with child, parent, and social-situational factors all influencing the child’s actual
behavior.
In this model the individual factors unique to a child play a significant role in their
assessment of risk. The limited research on the role of age and hazard identification has
focused on children ages 6 years and older, and this work shows that hazard identification
generally improves with age. However, there is some evidence that a child’s temperament
may play a more significant role than their chronological age in making hazard assessments.
Gender also plays a role in risk taking and in general boys engage in greater risk taking than
do girls. Whether this is an inherent gender difference or whether it relates to other
temperamental factors remains unclear. There is no question that a child’s temperament has
a very significant effect on their hazard assessment and risk-taking behaviors. Children who
judge the danger of falling to be low also judge their own personal physical ability for injury
to be low and they believe that the potential severity of an unlikely injury will be minor, and
consequently they appear more likely to engage in risky behaviors. Children who attribute
injuries and accidents to “bad luck” also are more likely to engage in risky behaviors than
those who attribute these to their own behavior. There appear to be cognitive differences in
the judgments that boys and girls make about the consequence of risk taking and girls
generally ask “can I get hurt” whereas boys ask “how hurt might I get.” Girls are more likely
to attribute injuries to their own behaviors and boys are more likely to attribute these to
“bad luck.” Related to this, the emotional experience of risk taking also affects the
probability that this will occur. Boys generally are more likely to report positive feelings such
as fun and excitement as associated with risk taking whereas girls are less likely to experience
these emotions. Experience and motivation also exert influences. The more children
experience an activity the greater their tolerance for risk-taking behavior. The more success a
child has previously experienced in a risky situation, the greater their motivation to engage in
a similar behavior in the future. Boys in particular tend to have over-inflated beliefs about
their abilities to manage risks whereas girls appear to focus more on the issues of safety in a
risky situation. Other temperamental factors that influence risk taking include impulsivity,
general activity level, and sensation seeking behaviors. Children who are “thrill seekers”
engage in risky behaviors and they also tend to overestimate their own physical abilities.
Family and parenting practices have a significant impact on a child’s risk-taking behavior.
Parents tend to caution their daughters about risk taking and inform them about their
vulnerability for injury whereas they explicitly encourage risk taking by their sons. Mothers
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intervene more frequently and faster than fathers in preventing risky behaviors, especially by
their daughters. Daughters are more likely to comply with parental expectations about
behavior whereas sons are more likely to exceed parental expectations and engage in greater
risk. Girls are more likely to report near injury events or minor injuries than are boys. Raising
a child’s awareness of parental expectations is likely to be more successful in influencing risk
decisions by girls than by boys. That being said, the best predictor of a child’s current safety
practices is parental teaching about such behaviors. Parents who display risky behaviors
while demanding safe practices from their children are less effective at influencing the child’s
risk decisions than parents whose behavior is consistent with their message. Other family
members also influence a child’s risk decisions. Older same-sex siblings strongly influence
the decisions of younger children. Older girls are more focused on safety-related issues with
younger siblings, whereas older boys are more focused on having fun with their younger
siblings.
The influence of individual and family factors is mediated by social-situational influences.
Group pressure exerts a strong influence on the behavior of young children (6-years-of-age
and older have been studied). By the age of 8 a child is more open to oral persuasion by their
peers. Young children also are more influenced by their friends than by their acquaintances.
They are also influenced by a desire to imitate the actions that they observe in other children.
It seems that the mere presence of an unknown peer observing their behavior is sufficient to
lead to riskier choices for both boys and girls. The presence of peers also allows children to
engage in cooperative activities in which they may aid each other and engage in risky
behaviors.
The model that has been developed to synthesize the factors that affect a child’s risk
decisions is based on research evidence that has mainly been collected for children age 6 to
12 years. Systematic research on the risk decisions of younger children has yet to be
conducted. The implications of the model for injury prevention suggests that the strategy of
targeting children’s attitudes, beliefs, cognitions and emotions may be the most successful in
influencing children’s safety practices. The authors note that such interventions need to be
developed in the context of the family, friends, community and culture of the child if they
are to have the greatest chance of success.
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Figure 3
Determinants of Children’s Risk
(Morrongiello and Lasenby-Lessard, 2007)
Children’s Climbing Skills
Climbing exercises children’s motor skills and allows them to explore their surroundings
from an elevated position. Children will climb or attempt to climb a wide variety of natural
and manmade objects. They will climb trees and rocks, they will climb ropes, ladders and
play structures, and they will climb walls and barriers. Climbing is a natural and normal
contributor to the development of the musculoskeletal system in children.
The act of climbing requires posture-kinetic coordination that develops throughout a child’s
early years and continues through into adolescence (Testa, Martin and Debû, 2003).
Climbing requires the coordination of many muscles, the strength to move parts of the body
against gravity, a sense of balance for the maintenance of postural equilibrium and stability in
different body postures and orientations, the ability to shift weight from limb to limb, and
the sufficient perceptual and cognitive development to allow for the desire and motivation to
ascend and even surmount an object. Seven different categories have been distinguished in
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the development of coordinated climbing skills (van Herrewegen, Molenbroek and
Goossens, 2004):
1. Coupling motor skill – the ability to couple movements together into a sequence to
create a smooth movement pattern.
2. Movement differentiation or complexity – the ability to differentiate and coordinate
complex movements (e.g., simultaneous singing and clapping).
3. Motor adaptation skills – the ability to adapt movement patterns to changing
circumstances.
4. Motor reaction skills – the speed and force of movements.
5. Rhythm – the ability to move rhythmically.
6. Movement orientation – the ability to appropriately orient the body in the desired
direction of movement.
7. Motor balancing skills – the ability to maintain postural stability and balance.
Skilled climbing requires the successful operation of all seven categories, but as young
children learn to climb the categories do not progress evenly and typically some are more
developed and some are less developed than others. Also, the rate of acquisition of climbing
skills will vary among individuals just as rates of maturation vary. Although there are large
individual differences in the acquisition of motor skills by young children, all normal children
follow the same general developmental rules:
• Motor skills develop inside to outside – the sequence goes from trunk to shoulders,
arms and finally hands.
• Motor skills develop from top to bottom – the arms get stronger before the legs.
• Motor skills develop from gross to fine – large movements by large muscles occur
before small movements by fine muscles.
Children begin to practice climbing skills early in life. Many children learn rudimentary
climbing before they begin to walk and climbing has been observed as early as 8 months of
age (McGraw, 1935, cited in Readdick and Park, 1998). By around one year a child is able to
pull himself up onto a ledge or table. By the age of 13 months many children have started
walking unaided. By 14 months 25 percent of children are climbing, and this rises to
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50 percent by 17 months (Readdick and Park, 1998). At 21 months 75 percent of children
are climbing and 90 percent or more are climbing by 22 months of age (ibid.). By 4 years of
age boys have started to develop greater upper body strength than girls. By the age of 6 years
many children can begin to climb in a manner similar to an adult (van Herrewegen,
Molenbroek and Goossens, 2004). As a consequence of these developmental processes, the
acquisition of climbing skills mostly occurs between 3 and 6 years of age (van Herrewegen
et al., 2004).
Climbing is part of children’s everyday play activities. Climbing is part of exploration. Young
children are encouraged to climb on play structures, indeed these are often called “climbing
frames.” From an early age children learn to climb on and off chairs, in and out of cars, and
up and down stairs. Children learn to climb up a ladder to descend a slide at the playground.
In physical education classes children learn to climb ropes and other structures. Climbing
skills are often reinforced by parents and teachers. Children climb for many reasons. Many
find it pleasurable. Children climb for enjoyment, mastery, and to practice their motor skills.
Some children climb for bravado, some to show off to their friends, some like the sense of
achievement and excitement of being atop a high object, some climb for solitude, and often
children climb to be on the other side of an object or to retrieve an object that has gone over
a barrier, such as a ball over a wall (Readdick and Park, 1998; van Herrewegen et al., 2004).
Chronologically, climbing skills emerge in stages at different ages, as shown in Table 4.
Although all children follow the same general sequence of development, at a given age there
is considerable variability in climbing skills.
Table 4
Development of Climbing Skills through Age 6
(adapted from van Herrewegen et al., 2004)
Age Range
6 – 8 months
9 – 12 months
1 – 1.5 years
1.5 – 2 years
2 – 3 years
3 – 4 years
4 – 6 years
Climbing Activity
Rolling, crawling
Holding on to furniture and objects, awareness of “visual cliff,” early aided
walking
Starting to walk unaided, negotiating small steps <8 in (20 cm), pulling the
body up using vertical using rails, climbing out of crib
Improved walking and stepping over objects, negotiating stairs improves,
climbing on a slide and sliding, maintaining balance, running
Better balance, climbing higher obstacles, little or no fear of heights
Good balance, jumping over objects, good and bad climbers appear, social
and cooperative play, some fear of heights and falling
All the seven aspects of climbing skills are being developed. Children
negotiate stairs and ladders unaided. Better balance. Children start riding a
two-wheel bicycle. Some are able to climb a rope. Still little physical difference
between boys and girls.
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In young children aged 4 or less there are no consistent gender differences in fence climbing
abilities (Nixon, Pearn and Petrie, 1979).
Climbing patterns can be categorized into six stages (Readdick and Park, 1998):
1. Anticipatory behaviors – children approach an object to be climbed with curiosity.
The child explores the object visually and through touching it. The child may kneel
and rock back and forth in front of the object.
2. Clambering – children use their arms to hold on to the object to be climbed then
swing one leg, usually stiff or slightly bent, up and over the object and pull their body
up with the strength of their arms (e.g., climbing on to a sofa).
3. Initial climbing – children use both hands to grasp an object at the same level, then
they pull up one knee or foot to a foothold, and then they raise the second knee or
foot to the same level. This pattern is repeated to climb the object. At this stage
climbing is tentative.
4. Transitional climbing – children use both hands to grasp an object at the same level
and then they pull up one foot to a foothold and sometimes follow this by raising
their other foot to the same level or to a different level so that their feet move in an
alternating pattern. Sometimes ipsilateral and sometimes contralateral hand and foot
movements are made.
5. Elementary climbing – children use both hands to grasp an object at the same level
and then they raise one foot to a foothold, then they reach higher with their
opposing hand and once they have a grasp they raise their other foot to a higher level
than the first. Climbing continues in an alternating movement pattern. Climbing
consists of weight shifting from side to side.
6. Mature climbing – children may start climbing using one hand and then engage the
alternating pattern of movements in a fluid climbing style.
Variants on climbing movement patterns depend on the objects being climbed, for example,
children may shinny up a pole or a rope.
The progression in motor skill development in young children is summarized in Figure 4.
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Figure 4
Gross Motor Development in Young Children
(adapted from van Herrewegen and Molenbroek, 2005)
6-9 months
9-12 months
9-18 months
12-24 months
25-36 months
15-30 months
Several factors play a role in the development of climbing skills and account for individual
differences between children, including:
• Personality—Dare-devil disposition, no fear of heights
• Exercise (how physically active is the child—physically active children tend to be
better climbers because activity builds strength and coordination)
• Motor development (age—older children are better climbers than younger children)
• Strength—especially in the arms, hands and legs, although for climbing arm and hand
strength is more important than leg strength for young children
• Body weight, in combination with strength (lean and strong vs. weak and obese).
Lighter children are often are better climbers than heavier children.
• Physique (light or heavy build) and the degree of muscle development
• Physical flexibility
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• Living environment (city child or small village child)
• Family members (does the child have older brothers and sisters)
• Footwear (shoes or barefoot)
• Body and limb length
In the above list, anthropometric differences appear to play a more minor role than physiokinetic development, personality and climbing technique (van Herrewegen et al., 2004). As
children grow they develop better muscle coordination and movement control and their
muscle strength increases. Hand and arm strength are important for climbing success and by
18 months of age children pull themselves up by their arms when climbing (ibid.). Hand grip
strength has been measured for boys and girls aged 3 to 10 years when grasping a handle
(Owings, Chaffin, Snyder & Norcutt, 1975). The results for boys and girls combined suggest
a linear increase in strength with age in the range that was studied and these results are
shown in Figure 5.
Figure 5
Hand Grip Strength Changes with Age
(Owings et al., 1975)
NOTE: 1 kilopond (KP) = 2.20462 pounds force (lbf) = 9.80665 Newtons (N)
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This research showed that on average boys had a stronger grip than girls and that this
increases by some 20 percent between 3 and 4 years of age. Interestingly, the maximum grip
strength of 4-year-old girls exceeded that of boys (see Table 5).
Table 5
Hand Grip Strength Changes with Gender and Age
(Owings et al., 1975)
Age
3 years
Gender
Mean
Maximum
Male
11.5
(51.2)
17.6
(78.3)
Female
7.9
(35.1)
9.0
(40.0)
Male
13.9
(61.8)
19.2
(85.4)
Female
12.1
(53.8)
25.6
(113.9)
NOTE: Units are pounds force (lbf) and Newtons (N) in parentheses.
4 years
Researchers have studied the hand grip preferences of 223 children and 59 adults when
asked to climb a 7 ft (~2.1 m) ladder with rungs that were 1 in (~3 cm) diameter and the
ladder was angled at 45º, 90º, and 180º (horizontal) to a wall (Gabbard and Patterson, 1980).
Table 6
Age Differences in Ladder Climbing Grips
(Gabbard & Patterson, 1980)
Age
N
2
32
3
4
Angle
32
32
45
Thumb Over
Bar
100.00
Thumb Under Bar
Mixed Grip
90
40.91
59.09
180
40.00
50.00
45
96.88
3.13
90
65.63
25.00
9.38
180
56.25
37.50
6.25
45
100.00
90
56.25
40.63
3.13
180
78.13
18.75
3.13
Results showed that 97 percent children used a thumb under grip for the 45º ladder climbing
task; there was a 50/50 split between a thumb under and a thumb over grip for the 90º
ladder climbing task; and a majority used a thumb over grip for the 180º (horizontal bar).
Results for children aged 2, 3, and 4 years old are shown in Table 6.
Although the arms are the main limbs used by young children for climbing, a number of
additional factors will help to determine whether a child will become a good climber or not.
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These include cognitive and attention factors, fluidity of movement, agility, fearlessness and
technique (van Herrewegen et al., 2004). These factors are summarized in Table 7.
Table 7
Characteristics of Good and Bad Climbers
(adapted from van Herrewegen et al., 2004)
Good Climbers
Aware and attentive – frequently look around,
look up to where they are going
Multitasks – climbs while talking, looking,
eating, playing
Often uses two support points
(one hand, one foot)
Moves with great ease and smoothness
Does not stop during climbing and climbs fast
Use many climbing techniques
Strong enough to carry their own weight
Dare devils and fearless
Move with rhythm
Take alternating steps when climbing
Bad Climbers
Look at their own hands and feet during
climbing to control their movements
Absorbed and focuses all attention on the act
of climbing
Use three support points
(two hands, one foot; two feet, one hand)
Say close to object being climbed
Frequently stop to look for support or to look
down. Climb slowly.
Often do not know how to climb an object
Not strong enough to carry their own weight,
often overweight
Cautious and frightened of heights
Lack rhythmic movements
Put feet next to each other before each upward
step
As children learn to climb they also make use of any environmental aids to assist them in
climbing, such as grabbing hold of adjacent objects, standing on top of objects, pushing
against objects, pulling themselves up using any available supports including using their
knees to help to pull themselves up, and throwing one leg up to where their hand is and
pulling themselves up (ibid.). As children grow so the size and scope of objects that they can
climb increases. It has been noted that “anything that can be climbed will be climbed”
(Greenman, 1988, cited in Readdick and Park, 1998). In short, children, like many famous
mountain climbers, will often climb an object simply “because it is there” (Readdick and
Park, 1998). Children who are 5 years or older can quickly scale even very high barriers
(Nixon et al., 1979) and they often take pride in their prowess in doing this.
Some examples of the kinds of products that children climb at different ages are shown in
Table 8.
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Table 8
Examples of Objects that a Child will Climb at Different Ages
(adapted from van Herrewegen et al., 2004)
1-3 Years
Successive platforms
Platform
Wire fence, fence with rails
Irregular shaped objects
Angled plane with few support points
Objects that are Climbed
House stairs, stairs on the slide
High chair, normal chair, cupboard, table
Baby crib
Cushions, mattress, pillows, boulders
Small slide
4-6 Years
Climbing frame
Wire fence
Angled plane with few support points
Angled or horizontal rope network
Angled climbing wall
Platform
Climbing frame with irregular steps, hoops
Fence
Small slide
Climbing rope, mesh, net
Playground climbing wall
Table, climbing frame
Children’s climbing brings physiological, psychological, sociological and biological benefits
to the maturing child and consequently climbing is encouraged by the equipment design of
modern playgrounds (Frost, Sutterby, Therrell et al., 2002). In addition to aiding in the
neuromuscular maturation of the child and the child’s social development through
collaborative and competitive climbing activities, these authors also note that a well-designed
playground teaches children about basic principles of physics, such as gravity, inertia,
pendulums and optics. The importance of climbing activities in the physical development of
the child is further reinforced by school playground and gymnasium equipment. Against this
desire to encourage children to develop their climbing skills are concerns about children’s
falls and their safety on climbing equipment. As a result of these concerns restricting the
height of playground equipment is recommended by every major national playground safety
organization (ibid.).
Children’s Interaction with the Built Environment
Ladders
A ladder is a vertical or inclined set of rungs or steps fixed inside of two outer frame
members and it is different to stairs which also allow for the ascent to or descent from a
height (see Figure 6). In EN-1176-1 (1998) a ladder is defined as “the primary means of
access incorporating rungs or steps on which a user can ascend or descend.” A ladder is
normally inclined at an angle between 60° and 90° to the horizontal (section 3.10). A ladder
is distinct from stairs which are defined in the standard as the “primary means of access
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incorporating steps on which a user can ascend or descend. Stairs are normally inclined at an
angle between 15° and 60° to the horizontal (section 3.11).
Figure 6
Illustration of Ladder and Stairs
(from van Herrewegen and Molenbroek, 2005)
Ladder
Stairs
In children’s playgrounds there are many structures that have to be accessed by a ladder. The
effects of different ladder designs have been tested with young children (van Herrewegen
and Molenbroek, 2005). This work shows that many children younger than 36 months of age
and all 3-4-year-old children tested are able to climb a vertical ladder with a first rung height
of 15.75 in (40 cm); 18 percent of children under three years can climb a vertical ladder with
a first rung height of 23.6 in (60 cm) and 50 percent of children aged 3 to 4 years can climb a
ladder with a first rung height of 27.6 in (70 cm). A ladder can be made from various
materials, such as wood, metal, plastic or rope and it can be narrow or broad. It can be of
varying length. A ladder can have normal, conventional horizontal rungs, or these can be
alternating (see Figure 7). The alternating rung pattern is used mainly in industrial ladders
(e.g., Lapeyre Stairs – www.lapeyrestair.com). The normal rung pattern can be achieved with
rungs that span two vertical uprights, or there can be a single central upright or the rungs can
be cut into the upright.
Figure 7
Ladder Rung Patterns
(adapted from van Herrewegen and Molenbroek, 2005)
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The term the “ladder effect” temporarily was used in some building codes with reference to
the presence of horizontal rails that potentially could create ladder-like rungs that could
facilitate climbing by young children (Leto, 2000). However, the term has not been formally
defined; precisely what constitutes a “ladder effect” has not been discussed in detail in any
peer-review journals, the term has not been systematically researched and is no longer
included in any current building codes.
Children’s Falls from Buildings and Structures
According to Newton’s first law of motion, what goes up must come down. This holds true
for children climbing, but unfortunately they do not always make a controlled descent from
an object but rather they fall off and suffer a sometimes fatal injury.
Falls are the second leading cause of death in the United States (Marshall, Runyan, Yang
et al., 2005) with more than 13,000 deaths in 1998, of which 126 were children aged 14 years
or younger (Bull, Agran, Gardner et al., 2001). Across the United States, falls represent up to
4 percent of childhood fatalities, but in urban areas this increases to up to 20 percent of
deaths from unintentional injury. Fatalities seldom occur when falls are from the second
story or lower (ibid.). Preschool children usually fall from windows and older children from
rooftops, fire escapes or balconies, especially during the summer months. The analysis of the
NEISS data described in Appendix B indicates that the annual fall rate from guards is
considerably less than 1 percent of injuries resulting in emergency visits among children aged
18 – 48 months.
The prevalence of risk and protective factors for falls in homes was estimated from the
results of a nationwide telephone survey of 1003 U.S. households. The reported prevalence
of falls in the home in the previous 12 months that required medical attention was 7 percent
overall, and this was higher if there were young children aged 6 or under (9 percent) or
elderly adults (11 percent). Falls were strongly associated with stairs, the absence of railings,
and the use of ladders. Households with young children or older adults reported greater use
of appropriate anti-fall devices, such as safety gates on stairs (Marshall, Runyan, Yang et al.,
2005).
In a retrospective analysis of 729 accidental or unintentional fall patients (393 low-level and
336 high-level) treated from 1992 through 1998, researchers found that over 60 percent of
the falls occurred between the ages of 10 months and 4 years (Wang, Kim, Griffith et al.,
2001). Of these falls, 21.8 percent were from windows, 15.3 percent were from balconies or
fences, and 12.1 percent were from stairs. In this period there were 12 fatalities from falls,
and eight of these were high falls (>15 ft [4.6 m]) from windows or balconies. The mortality
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rate was 2.4 percent for high-level falls (>=15 ft [4.6 m]) compared with 1.0 percent for lowlevel falls (<15 ft [4.6 m]). Intracranial injury accounted for the majority of deaths from falls.
Intracranial and abdominal injury risks were similar for children suffering low-level falls
compared with those who fell from greater heights. High-level falls resulted in more
orthopedic and thoracic injuries and low-level falls resulted in more abdominal injuries. All
four low-level fall deaths had pre-existing abnormal head computed tomography (CT) scans
and intracranial hypertension. Intracranial injuries caused 50 percent of high-level falls
deaths and 50 percent were caused by severe extracranial injuries. Other research has shown
that children have relatively flexible bones and will use their arms to protect their heads (Bull
et al., 2001), and children aged 3 years or younger are less likely to suffer serious injury than
older children who fall the same distance because they have less muscle mass and more
cartilage and fat to dissipate the kinetic energy of the fall (Ivatury, 2005).
In a systematic review of the literature (Khambalia, Joshi, Brussoni et al., 2006) searched
electronic databases from 1966 to March 2005 to identify 14 empirical research studies that
systematically evaluated unintentional fall injury risk factors for children aged 0–6 years. The
major fall injury risk factors included the child’s age, sex (boys fell more), height of the fall,
type of landing surface, mechanism (child was dropped, fell on stairs or fell using a infant
walker), setting (day care versus home care), bunk beds, and low socioeconomic status. The
authors concluded that age, sex, and poverty are independent risk factors for injuries due to
falls in children.
A retrospective analysis of head injuries/multiple trauma for 241 children aged 16 years or
under over a seven-year period in Zurich compared cases to random controls (Mayer, Meuli,
Lips and Frey, 2006). Of those children with head injury, 31 (13 percent) had fallen out of a
building, and 27 (87 percent) of these children had fallen from the third floor or lower. Twothirds of falls (68 percent) occurred at home (21 falls) and 15 children (49 percent) had
climbed on furniture before falling. The authors note that “dangerous balcony construction
“caused five falls (15 percent), but they do not describe how the balconies were judged to be
constructed dangerously. Except for three cases (10 percent) with direct parental
involvement (one mother jumped out with her child, two mothers threw their child out of
the window), parents did not witness the fall which shows that the children were
unsupervised. Two children (6 percent) attempted suicide. Children aged 0-5 years were
predominantly represented (84 percent), and all six children who died were in this age group.
Most falls occurred among younger children of foreign nationals of lower socioeconomic
status and in the summer months.
Analysis of the statistics on falls reveals several consistent trends: fall risks are greater in
older, multi-story, low-income housing; there is a higher rate of falls among young males
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than females; and risks are higher for African-American and Latino children (Bull et al.,
2001; Mayer et al., 2006).
Environmental considerations and materials also play important roles in the risks of and
consequences of falls. For example, surface dryness may be an issue because research has
shown that falls on wet linoleum result in greater femur torque than falls on dry linoleum
(Deemer, Aguel, Bertocci et al., 2003). Surface type and fall height have been also been
shown to influence the biomechanics associated with injury risk in feet-first free falls and
forces are less for falls onto playground foam than onto wood, linoleum or padded carpet
(Bertocci , Pierce, Deemer et al., 2004). Other considerations include the thermal
conductivity of the material, for example, metal will heat up or cool down more rapidly than
wood and consequently metal will feel less comfortable to the skin and this may discourage
climbing. Materials that are flexible, such as wires, may allow a child to deform them and be
able to either climb or squeeze through the barrier.
Windows
Falls from windows are among the most common types of unintentional injuries to children
and they are a major public health concern, especially in urban communities in North
America (e.g., Benoit, Watts, Dwyer et al., 2000; Istre, McCoy, Stowe, et al., 2003; Stone,
Lanpear, Poemrantz & Khoury, 2000; Vish, Powell, Wiltsek and Sheehan, 2005; Meyer,
Thelot, Baugnon, and Ricard, 2007). According to the CPSC, in 1993, 90 percent of falls
were from windows on the first or second stories of buildings, and these resulted in a variety
of injuries. Of those, 45 percent were fractures, internal injuries, concussions, hematomas,
and hemorrhages (Bull et al., 2001). The American Academy of Pediatrics reports that some
3 million children per year require treatment for fall-related injuries and that falls result in
around 140 deaths annually in children less than 15 years of age (Bull et al., 2001).
An analysis of hospital admissions for 2,322 children, aged 0-14 years, for the period from
January 1991 through November 1999, showed that 41 percent of admissions resulted from
a fall and 11 percent of these were falls from windows (Benoit et al., 2000). The overall
mortality rate was 4 percent and 83 percent of these cases were children aged 0-4 years
(ibid.). Between the years 1992-1994, the national cost of fall injuries to children was
$958 million went (Bull et al., 2001). In Los Angeles County, for fall-related injuries cost
more than $600,000 or about $5,000 per child over a two-year period (1986-1988).
In an analysis of 1,363 fall injuries treated over a seven-year period from January 1, 1991 to
December 31, 1997, Stone et al. (2000) found that 6.3 percent (86) of all the incidents
involved falls from windows. There were 69 incidents involving falls in children aged 5 years
or younger and these young children were over seven times more likely to be involved in a
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fall than those aged 5 to 14 years (14.6/100,000 versus 2.0/100,000). Fall incidents were
twice as common among boys (55 incidents, 8.2/100,000 annual incidence rate) as girls
(33 incidents, 4.8/100,000 annual incidence rate) and African-American children were three
times more likely to fall (47 incidents, 13.1/100,000 annual incidence rate) than children
from other non-black ethnic groups (39 incidents, 4.1/100/000 annual incidence rate). The
fall incidence rate was four times greater in urban Cincinnati (64 incidents, 11.6/100/000
annual incidence rate) than in surrounding suburban or rural areas (22 incidents,
2.8/100/000 annual incidence rate). The mortality rate for falls from windows was
4.7 percent which was significantly greater than for other falls (0.07 percent). AfricanAmerican male children aged less than 5 years and living in an urban setting were the highest
risk group for a fall from a window. Unfortunately, the study does not indicate any design
variables associated with the falls, such as the window height, whether or not it was open
and whether or not there was a guard present.
A retrospective analysis of pediatric trauma patients admitted to a trauma center in Northern
Virginia, between January 1991 and November 1999, was undertaken to determine the risk
factors for fall incidents (Benoit at Al, 2000). During this period there were 102 falls from
windows (11 percent of all falls) and one-third of the children falling from a window were
admitted to the hospital between 1997 and 1999. Most of the children who fell from a
window were boys (62 percent) and aged less than 4 years (83 percent). Most falls
(70 percent) were from a second-story window. Most incidents were not witnessed by an
adult. The study did not consider the role of any design variables in either facilitating or
preventing the occurrence of a fall.
A Swiss study retrospectively analyzed 241 child head and/or multiple trauma injuries over a
seven-year period at a Zurich hospital (Mayer, Meuli and Lips, 2006). Of those injuries, 31
(13 percent) were associated with a fall, and of these 15 cases fell from a window, 13 cases
fell from a balcony, one fell through a door, and one fell from a roof. In seven of the
window falls the child used a nearby chair, sofa, bed, bedside table, or window ledge to climb
to the window. Five of the balcony falls were attributed to dangerous construction, although
no design details of why construction was judged dangerous was provided. In eight of the
balcony falls the child used a nearby chair or dustbin to climb the balcony.
In Dallas County, Texas there were 98 fall injuries to children under 15 years of age from
1997 to 1999 and 40 percent of these cases required hospital admission (Istre et al., 2003).
Most of the falls (77 percent) occurred in apartments and 52 percent were falls from
windows compared with 45 percent from balconies. Researchers visited the apartments and
took measurements of design variables. Most of the apartments were built before 1984 at a
time when building codes allowed for rail spacing of up to 9 in (22.9 cm), and they had not
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been upgraded to meet current code requirements for rail spacing. Results showed that the
window was unguarded and located within 24 in (61 cm) of the floor for more than twothirds of window-related falls. The balcony rails were an average of 7.5 in (19 cm) apart and
the child fell from between the balcony rails for more than two-thirds of balcony related
falls. Injury rates were higher for Hispanic and blacks in comparison to whites, because
many lower socioeconomic families lived in the higher–risk low-income apartment
complexes. Of the 17 falls from balconies in this three-year time period, only four were from
private balconies whereas 13 were from common balconies that connected apartments. In 15
of these falls the balconies were made of metal and in 11 instances the children had fallen
between the balcony rails which were at least 5 in (13 cm) apart. All of the apartments
involved were built prior to 1984 when the building code allowed for a rail spacing of up to
9 in (23 cm).
An analysis of 90 fall cases (55 were male) in Chicago involving young children (median
age = 2 years) between 1995 and 2002 showed that 98 percent of falls were from the third
floor or lower (Vish et al., 2005). Researchers visited 77 fall sites and found that 96 percent
were in four-story buildings or lower. Head trauma and extremity fractures were the most
common injuries, though three patients died. Researchers noted that among Chicago
preschool children window falls are a frequent cause of injury (15/100,000), and that public
health efforts have successfully decreased window fall injuries in Boston and New York
(ibid.).
In many instances, children fall through open and unguarded low bedroom and living room
windows. These accidents can be prevented by installing steel window screens constructed
to withstand a body weight up to 150 lbs (67.5 kg) (Bull et al., 2001). Installation of window
guards is a proven preventive strategy. In 1976, the New York City Board of Health
implemented a policy to mandate window guards in homes with children ages 10 and
younger and this resulted in a 35 percent reduction in deaths attributed to falls from
windows, a 50 percent reduction in incidents, and a 96 percent reduction in hospital
admissions due to window-fall-related injuries (Bull et al., 2001).
Year 2000 data from the Kids Inpatient Database (KID-HCUP) were used to analyze the
demographic risk factors, incidence, and patterns of injury resulting from falls from
buildings and calculate a national estimate of hospital admissions due to falls from buildings
in the United States (Pressley and Barlow, 2005). In 2000 there were 2,163,402 people aged
18 years of younger who were discharged from U.S. hospitals, and of these, 0.0005 percent
(1161) were acute injuries from falls from buildings or structures. Of these falls, 6 percent
were intentional falls or jumps (70 persons). Based on these figures the estimated annual
cumulative incidence of unintentional falls from buildings or structures requiring emergency
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or urgent hospital admission for children aged 0-4 years was 4.6 per 100,000 children. This
was affected by ethnicity and the estimated cumulative incidence of serious falls for young
children of Hispanics was 5.48, for African-Americans it was 4.82, and for whites it was 2.72.
Although the reason for the fall was not analyzed, the authors infer that a majority of these
are the result of falls from windows rather than from balconies or other building structures.
They note that New York City has had a window guard law for many years and that in 2001
there were only 30 fall incidents in New York City, no fatalities and most of the falls
involved older adolescents. They state that:
“Window guards have potential to provide affordable, effective prevention
of injuries in developing societies where the population is disproportionately
young and living in warm climates, and where high rise and multiple storey
buildings are being used increasingly to alleviate overcrowding.” (page 272).
They conclude that window guards and fall prevention programs are associated with reduced
injury resulting from falls from buildings and should be mandated in multifamily dwellings
where small children reside. Indeed, a drastic decline in window-related falls quickly followed
the introduction of the New York City window guard legislation in 1976: within three years
the number of incidents had decreased from 217 to 80 and in 2002 there were only three
incidents (New York City Department of Health and Mental Hygiene, 2007). Thus, as noted
by Stone et al. (2000), window falls may be endemic but they are preventable with the use of
window guards. In addition, Meyer, Thelot, Baugnon and Ricard (2007) have called for more
environmental education on window fall risks with information being provided in multiple
languages, and with a focus on high-risk warm periods (spring, summer).
Stairs
The Consumer Product Safety Commission (CPSC) has reported that stair-related falls,
mostly in homes, are associated with an estimated 2 million injuries and 1,000 deaths each
year in the United States (Sanders, 1993). Several factors impact the risk of a fall on the
stairs, including the lack of or improperly placed handrails, the height and depth of treads.
Riser heights should be between 4 in (10 cm) and 7 in (18 cm) and tread depths should be at
least 11 in (28 cm). The edges on treads should be clearly visible. Research shows that
children learn to climb stairs early in life and that they quickly master the skills necessary to
climb a stair rail.
Judgments about stair climbing requirements for normal healthy people seem to be based on
a perceptual invariant, namely the angle defined by the ratio between the height of the stair
and the distance taken from the feet to the top edge of the stair before the initiation of the
movement (Cesari, Formenti and Olivato, 2003). In spite of differences in the kinematics of
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the motion, anthropometric dimensions, and the skill and ability exhibited, this angle is the
same for children, young adults and older adults. Their research shows that although stair
climbability judgments often seem to be based on the simple ratio leg length-stair height, and
that this is influenced by differences in age, participants of all ages use the above common
perceptual variable to coordinate their stair climbing actions.
Berge, Theuring and Adolph (2007) conducted a study of 732 parents who were asked when
and how their children learned to climb stairs. Results showed that mastering climbing up
stairs typically began around the age of 11 months and that children learned to climb down
the stairs at around 12 months of age. Those children living in homes with stairs learned to
climb these at an earlier age than those without stairs in the home.
A U.K. study noted that annually there are some 7,500 falls on stairs, in which stair guarding
plays a role, that result in an injury requiring hospital attendance and of these falls,
57 percent are the result of children falling off or over stair guarding and 17 percent are the
result of children falling through or under stair guarding. The U.K. Building Regulations call
for a stair guard that is 90 cm (35.4 in) high so that it is not readily climbable by children. To
further investigate the issues associated with stair guard design a two-phase study was
undertaken (Riley, Roys and Cayless, 1998). In Phase one, 32 children aged 4 years (13
children), 5 years (12 children), and 6 years of age (7 children) were observed freely playing
to see whether they would climb the stair guarding on five step play stairs. Anthropometric
measures were taken of those children who chose to climb on or over the guard. In Phase
two a different group of children was asked to try to climb the stair guard. This group also
comprised 4-year-old (6), 5-year-old (8), and 6-year-old (6) children and their climbing
strategies were observed and video recordings were used to assess their climbing time.
Physical measurements were taken of those who attempted to climb the stair guard. Results
show that a 35.4 in (90 cm) guard rail can be climbed by a majority of 4-, 5-, and 6-year-olds.
Younger children attempted to climb after watching older children. For both phases of the
study more boys attempted to climb the stair guard than did girls. The physical dimensions
of the children were comparable to published anthropometric data for height, leg length, and
overhead standing reach distance to grip an object. In the phase two study only one child
was unable to climb the guard (a 4-year-old boy). In phase two the mean climbing time was
13.2 seconds but the range was wide varying between 3.2 seconds to 40.9 seconds. There
was no evidence that taller children were more skilled or climbed faster than smaller
children. Analysis of the video recordings identified three strategies that different children
used to climb the guard rail. These strategies are shown in Figure 8. Strategy 1, which is most
common and favored most by taller children, involved using both hands to hold the top of
the rail, then raising one knee or lower leg onto the rail, and hoisting the torso on the rail.
Shorter children favored strategy 2 where both hands grasped the rail and the child used
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upper body strength to lift the torso onto the rail and then brings one bended knee to the
top of the rail. The third strategy, which was used least often, involved grasping the top rail
with both hands and then bracing a bended knee against the side of a guard rail to gain the
height required to climb the guarding. During free play the observers also noted situations
where children helped each other to climb the guard and younger children were influenced
and frequently abetted by their elders in climbing. In summary, almost all children were able
to climb a 35.4 in (90 cm) stair rail and while the child’s height, leg length and reach all
impacted climbability, children tended to adopt one of three climbing strategies.
Figure 8
Three Different Strategies for Climbing a Stair Guard
(Riley, Roys and Cayless, 1998)
Climbing strategy 1
Climbing strategy 2
Climbing strategy 3
Based upon their observations, the researchers created a flowchart to illustrate the sequence
of events and the various factors that influence the likelihood that a child will climb a stair
guard (Figure 9). The process begins with the child deciding whether or not to try to climb
the stair and various individual factors are thought to influence this process including
personality, maturity, and motivation. The presence of a reason, such as permission to climb,
also aids in the initial decision. Once the child has decided that there is no restriction then
they will attempt to climb. The ability to successfully climb the guard will be influenced by a
variety of individual physical factors, such as the height, age, and agility of the child. If the
child is unsuccessful in climbing then the child may look for something to assist with
climbing. If the child has managed to raise their body off the ground but is unable to
complete the climb then there is the potential for a minor injury when they fall off the guard
or a more serious injury if they fall down the stairs as a result of this behavior, otherwise the
child successfully climbs guard.
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Figure 9
Model of the Stair Guard Climbing Decisions Process in Young Children
(redrawn from Riley, Roys and Cayless, 1998)
Playgrounds and Ladders
The ability of young children aged 0 to 4 years to climb vertical ladders of different designs
has been studied (van Herrewegen and Molenbroek, 2005). In particular, the study sought to
determine the height of the first rung of a ladder that these children can climb unaided.
Results are shown in Figure 10. Around one-third of children aged 12-24 months were able
to climb a ladder with the first rung at 15.75 in (40 cm) above ground level but all children
36 months and older could climb this. By the age of 3 years almost half of the children could
climb a vertical ladder with the first run set at 27.5 in (70 cm).
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Figure 10
Effects of First Rung Height on Ladder Climbing Success at Different Ages
(plotted from van Herrewegen and Molenbroek, 2005)
100
90
% Climbing Success
80
70
60
12-24 mths
50
24-30 mths
40
30-36 mths
36-48 mths
30
20
10
0
30cm
40cm
50cm
60cm
70cm
First rung height
Although children’s age alone was not a very good predictor of their climbing skills, by age
3 years their motor skills were sufficiently developed to allow climbing a vertical ladder with
a variety of rung heights. Interestingly, at all ages tested the children found the slanted
ladders to be more frightening to climb than vertical ladders.
A study of the frequency of use of play equipment in public schools and parks in Brisbane,
Australia, was undertaken to estimate an annual rate of injury per use of equipment (Nixon,
Acton, Wallis et al., 2003). A random sample of 16 parks and 16 schools was selected and
children were observed at play on five different pieces of play equipment over a two-year
period. The ranked order for equipment use in the 16 schools for average daily use was
horizontal ladders (136), slides (61) and climbing equipment (52) and for the 16 parks it was
horizontal ladders (156), slides (92), track ride (69) and climbing equipment (20). The results
clearly show the popularity of horizontal ladders and other forms of climbing equipment
among the school children. Assuming 276 clear days per year, the authors calculated the
annual injury rates for the climbing equipment at the 16 schools to be 0.59/100 000 uses of
equipment and in the 16 parks to be 0.26/100 000 uses of equipment. The use of climbing
equipment aids in the growth and development of children and in this study the children
clearly availed themselves of the use of such equipment both at school and in public parks.
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The overall rate of injuries/100 000 uses of equipment was higher at school than in the park,
possibly reflecting an effect of parental supervision, but in both situations it was low overall.
The authors note that the benefit of further injury reduction strategies in this community
may be marginal and that these may outweigh the economic costs in addition to reducing
challenging play opportunities.
Safety Barriers
A safety barrier is a physical or non-physical means planned to prevent, control, or mitigate
undesired events or accidents and they can be passive or active barrier systems, and physical,
technical, or human/operational barrier systems (Sklet (2006). As noted by Nixon et al.
(1979) to be effective a safety barrier must combine three components:
1. Effective parental training in environmental safety for the child.
2. Present the child with a strong psychological deterrent.
3. Present a physical restraint to the child.
These same authors note that physical barriers can only ever be an adjunct to effective
parental training, and the design of the barrier alone can never replace effective
environmental safety training.
An effective safety barrier is not synonymous with one that is insurmountable. There may be
emergency situations, such as a fire, in which it is desirable that a child be able to scale the
safety barrier to escape otherwise they would be trapped and could perish. For a safety
barrier to be effective it should be impossible for the child to accidentally fall through or fall
over the barrier, but making it unclimbable may be neither feasible nor desirable. The child
should know that under normal conditions it is undesirable to attempt to climb over the
barrier and the barrier should be designed so that it does not encourage and easily facilitate
climbing behavior.
Climbing from Children’s Cribs
Ridenour (2002) observed 48 children, 17-32 months with mean age 26 months, climbing
from a crib. After children become comfortable walking some begin climbing. She tested a
standard wood crib that was 28 in (71 cm) wide x 52 in (132.1 cm) long x 26 in (66 cm) high
rail with 6 in (15 cm) thick crib mattress. All of the children were able to walk unaided and
all were < 35 in (89 cm) tall (mean = 33.7 in (85.6 cm), min. 31.5 in (80 cm), max. 34.8 in
(88.4 cm). Each child was observed climbing out of the crib four times. Results showed that
a large majority of children climb out of corner of crib (see Figure 11). Corner climbing was
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consistently used by 90 percent of children and it was used by 98 percent of children some
of the time.
Figure 11
Typical Corner Climbing Pattern
Figure 12
Typical Side Climbing Pattern
The side-climbing pattern was used by the remaining 10 percent of the children in at least
one of the four observations (Figure 12). The effective height of the crib side was 20 in
(50 cm) and children were able to climb over this barrier. Results show that the corners in
cribs usually are used by young children to aid their climbing, and that any potential catch
points at the corners should be eliminated because these can be a hanging hazard. One
implication of the results not discussed by the authors is that oval, elliptical or circular crib
designs should avoid the corner climbing strategy, and if the crib side is high enough at 36 in
(91 cm) this should prevent or minimize side climbing.
Child Protective Fencing
It is clear that well designed safety barriers, including balconies, railings, and stair rails
sometimes can be the difference between life and death for a child. The primary role of a
barrier is to eliminate the risk of accidental falls through or over this. There are many factors
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that affect the overall design of a safety barrier, including the cognitive development of the
child, the physical development of a child’s climbing skills, and environmental
considerations.
There are approximately 140 deaths from falls and three million children require emergency
department care for fall-related injuries each year in children younger than 15 years in the
United States (Bull, Agran, Gardner, et al., 2001). The risks of falls can be mitigated by
pediatricians and other child health care professionals advocating preventive strategies that
include parent counseling, community programs, building code changes, legislation, and
environmental modification, such as the installation of window guards and balcony railings.
Removing any hazards or reducing any risks to an acceptable minimum can create a safer
environment for children (Page, Powell, Wilson, and Ward, 1995). One effective strategy to
reduce hazards is to isolate these by using barriers, especially fence-like barriers used in the
home (stair gates and cooker and fire guards and products which have a barrier-function,
such as cots and playpens).
Good barrier design features are discussed in the following sections. However, it is notable
that there has been a lack of consistent design terminology in the studies that follow. The
reader should note the specific design characteristic of each type of fence tested rather than
simply relying on the name given to the fence. For example, in the United States research
conducted in the early 1990s a metal fence comprising mainly vertical bars is referred to as
an ornamental metal fence, whereas today it most likely would be described as a vertical
picket fence. It is stressed that conformance with building standards should be followed by
regular assessment of public safety issues and action as appropriate (Culvenor, 2002).
Fence Design: Australian Research
In young children aged 4 or less there are no consistent gender differences in fence climbing
abilities and, depending on the design of the fence, by the age of 2 years, 22 percent of
children can climb a 24 in (60 cm) fence, by the age of 3 years about 50 percent of children
can climb a 36 in (91.4 cm) fence, and 20 percent can climb a 48 in (122 cm) fence (Nixon,
Pearn and Petrie, 1979). These results are shown in Figure 13.
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Figure 13
Climbing Success at Different Ages for Different Fence Designs
(plotted from Nixon, Pearn and Petrie, 1979)
Fence Design: U.S. Research
Three studies were undertaken to evaluate swimming pool perimeter fencing design and the
fence-climbing abilities of young children in the high-risk age group for drowning in
residential swimming pools (Rabinovich, Lerner and Huey, 1994). In all studies they tested
pairs of children to provide social facilitation and encouragement for climbing. They asked
children to climb each of several fence designs without giving any instructions on how to
climb. All children were encouraged to climb as quickly as possible, preferably surmounting
the fence in less than 1 minute, with 3 minutes set as the upper limit for a trial. Age
appropriate prizes were offered to motivate children to climb the fences and these were
dispensed regardless of climbing success. When not climbing, the children were given timeout to play with toys, and a playful study atmosphere was maintained throughout.
The test apparatus comprised square elevated platform elevated 36 in (91.4 cm) above the
ground. The floor of the platform was padded with 6 in (15.2 cm) polyurethane foam blocks,
and the outer perimeter floor area was padded with 12 in (30.4 cm) of polyurethane foam
blocks. Different fence design sections could be fixed to three sides of the platform, each
section being 72 in (182.9 cm) long and these were varied in height, and the platform was
exited down a slide (see Figure 14). A hinged joint at each connection point allowed fence
sections to swing independently and each section had to allow easy movement of the section
to and from the test platform. After the fence sections were placed in position, clamps were
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used to hold the movable fence sections to the edges of the platform. To motivate younger
children some fence sections of 24 in (6 cm) and 36 in (91.4 cm) in height were used to
ensure initial success and maintain children’s motivation by ensuring periodic successes.
However, for the experimental testing all fence sections were at least 48 in (122 cm) high.
Figure 14
Example of Study 1 and Study 3 Apparatus
(Rabinovich et al., 1994)
Climbing Protocol and Success Measure
In the first study, each child was asked to climb each fence design at 24 in (6 cm), 36 in
(91.4 cm), and 48 in (122 cm) heights before proceeding to the next fence design, and the
different designs were tested in counterbalanced order. Success and time to success were
recorded during each session by three experimenters. All experimenters practiced their
timing skills by watching video-tapes of pilot sessions and until there was good agreement
with the lead experimenter’s time. All test sessions were videotaped.
For all sessions one experimenter was responsible for the welfare of each child during their
fence climbing attempts, a second experimenter stood at the bottom of the exit slide to
ensure the child’s safety leaving the platform and a third experimenter stood or kneeled
directly behind the child with arms and hands ready to catch the child during climbing
attempts but without providing any physical assistance. During climbing, the use of any part
of the platform or the fence-mounting structure as an aid in climbing; verbal or physical
assistance from the other child; success in climbing the fence with assistance from the other
child; and time required to climb the fence with assistance from the other child all were
recorded.
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If the child was able to climb the fence unassisted by the support structure or another
individual this was recorded as a success. Some children accidentally used the support
structure to assist them in climbing the fences and this was counted as a success and noted.
The success rate was the number of successes divided by the total number of trials.
Study 1 – Effects of Fence Design
The first study tested whether 60 children (22 girls and 38 boys) between the ages of 24 and
54 months could climb each of five fence designs, all set at 48 in (122 cm) height, that, with
the exception of a 2.5 in (6.35 cm) chain-link fence, conformed to the CPSC’s recommended
codes for swimming pool barriers (US CPSC, 1991):
1. Large diagonal chain-link – 2.5 in (6.35 cm)
2. Small diagonal chain-link – 1.25 in (3.18 cm)
3. Picket: Vertical members 4 in (10.16 cm) apart, with a 23 in (58 cm) gap between
horizontal members. Boards were 3.25 in (8 cm) wide. No decorative cutouts.
4. Stockade: a wooden fence with vertical members 0.25 in (0.6 cm) apart and a gap
between horizontal members off 2.3 in (5.8 cm). Essentially presented a solid wall.
5. Ornamental iron: Vertical members 3.5 in (8.26 cm) apart, with a 45 in (114.3 cm)
gap between horizontal members. No decorative cutouts.
An attempt was made to also test a removable nylon fence but because this could not be
kept taut it was excluded from the study. The following results were obtained for the
percentage climbing success and mean climbing times in seconds from this study:
• 24- to 36-month-old group – there was a statistically significant difference in
children’s ability to climb the different fence designs (Chi-square (5) = 86.8, p<
0.01). For this age group the large chain-link fence was easiest fence to climb
(75 percent success, an average of 25.6 seconds), especially compared to climb the
small chain-link fence (13 percent success, an average of 18.7 seconds: Chi-square
(1) = 19.05, p< 0.0001). No child was able to climb the picket, stockade or
ornamental iron fence.
• 36- to 42-month-old group – there was a statistically significant difference in
children’s ability to climb the different fence designs (Chi-square (5) = 28.7, p<
0.001). Large chain-link fence (92 percent success, an average of 21.9 seconds)
was marginally significantly easier to climb than small chain-link fence (58 percent
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success, an average of 19 seconds: Chi-square (1) = 3.6, p < 0.06). The picket
fence was climbed by 50 percent of children in an average of 24.2 seconds. No
child was able to climb the stockade and ornamental iron fences.
• 42-to 48-month-old group – there was a statistically significant difference in
children’s ability to climb the different fence designs (Chi-square (5) = 31.3, p<
0.001). All children could quickly climb the large chain-link fence in an average of
11.5 seconds and 92 percent of children could climb the small chain-link fence in
an average of 11.6 seconds. Less than half of the children could climb the picket
fence (42 percent) but those that succeeded climbed this quickly (an average of
12 seconds). Only 17 percent of children could climb the stockade fence (an
average of 14.5 seconds) and 17 percent could climb the ornamental iron fence
(an average of 20.5 seconds).
• 48-to 54-month-old group – there was a statistically significant difference in
children’s ability to climb the different fence designs (Chi-square (5) = 28.5, p<
0.001). All children climbed the large chain-link fence very quickly in an average
of 7.7 seconds and 83 percent of children could climb the small chain-link fence
in an average of 11.4 seconds. Over half of the children (58 percent) climbed the
picket fence in an average of 23.3 seconds, and 33 percent climbed the stockade
in an average of 11.3 seconds. The ornamental iron fence was the most difficult
to climb and only 8 percent of children succeeded with an average climbing time
of 11.4 seconds.
These results are summarized for climbing success in Figure 15 and for climbing time in
Figure 16. There were no significant differences in climbing success between boys and girls
for any of the fence designs. When children were able to use some other part of the platform
structure to assist with climbing then success rates for the ornamental iron fence were
13 percent (24-36 months), 8 percent (36-42 months), 25 percent (42-48 months), and
100 percent (48-54 months). However, results consistently showed that the ornamental iron
fence was the hardest design to climb unassisted and that when children were successful
then usually it took the longest to climb.
Study 2 – Effects of Fence Design Modifications
The second study tested whether 32 children (16 girls and 16 boys) between the ages of 36
and 48 months, could climb each of the five fence designs used in Study 1, but with the
presence of either a roller top rail made of a 4 in (10 cm) diameter free-spinning polyvinyl
chloride pipe or an angled plate top that was 2 in (5 cm) thick and 12 in (30 cm) deep. Both
modifications ran the length of each fence section (see Figure 17).
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Figure 15
Age and Design Effects on Climbing Success for a 48 in (122 cm) High Fence
(plotted from Rabinovich et al., 1994)
Figure 16
Age and Design Effects on Climbing Speed for a 48 in (122 cm) High Fence
(plotted from Rabinovich et al., 1994)
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Figure 17
Example of Study 2 Apparatus
(Rabinovich et al., 1994)
The following results were obtained for the percentage climbing success and mean climbing
times in seconds from this study:
• 36- to 42-month-old group – there was a statistically significant difference in children’s
ability to climb the different fence designs (Chi-square (8) = 143.1, p< 0.001). Almost
all children (95 percent) were able to climb the regular large chain-link fence in an
average of 12.8 seconds. Both of the top treatments significantly lowered the
percentage of successful climbing attempts for the chain-link fence (Chi-square (8) =
10.8, p< 0.01). The presence of the top roller decreased climbing success to 81 percent
and slowed climbing time to an average of 19.3 seconds. The presence of the angled
top plate decreased climbing success to 54 percent and slowed climbing time to an
average of 24.4 seconds. A few children (4 percent) succeeded in climbing the
stockade fence in an average of 14.1 seconds, but none climbed the modified
stockade. No child was able to climb the ornamental iron fence even when this was
unmodified.
• 42-to 48-month-old group – there was a statistically significant difference in children’s
ability to climb the different fence designs (Chi-square (8) = 48.6, p< 0.001). All
children could quickly climb the large chain-link fence in an average of 12.1 seconds.
The addition of the top roller decreased the percent climbing success to 80 percent
and slowed climbing time to an average of 18.6 seconds. The presence of the angled
top plate decreased climbing success to 50 percent but this actually reduced climbing
time to an average of 12 seconds. The stockade fence was climbed by 30 percent of
children in an average of 12 seconds, and 30 percent of children succeeded in climbing
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the stockade fence with top angle plate in an average of 14.6 seconds. No child
climbed the stockade fence with the top roller present. At this age 30 percent of
children climbed the ornamental iron fence in an average of 40 seconds. No child
climbed the ornamental iron fence with either the top roller or top angle plate present.
These results are summarized for climbing success in Figure 18 and for climbing time in
Figure 19. Analysis of the results by gender showed that girls were more successful than
boys in climbing the chain-link fence with the roller-top (Chi-square (1) = 3.94, p< 0.05) and
with the top angle plate (Chi-square (1) = 4.44, p< 0.05).
Figure 18
Age and Fence Design Effects on Climbing Success
(plotted from Rabinovich et al., 1994)
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Figure 19
Age and Fence Design Effects on Climbing Speed
(plotted from Rabinovich et al., 1994)
Iron+angled plate
Iron+roller
Iron
Stockade+angled plate
Stockade+roller
42‐48 mths
36‐42 mths
Stockade
Large chain link+angled plate
Large chain link+roller
Large chain link (2.5")
0
5
10
15
20
25
30
35
40
45
Mean Climbing Time (sec)
Study 3 – Effects of fence height
The third study tested whether 48 children (22 girls and 26 boys) between the ages of 24 and
48 months, could climb each of the five fence designs used in Study 1, but with a variable
fence height of 48 in (122 cm), 54 in (137.2 cm) and 60 in (152.4 cm). The same apparatus as
in Study 1 was used (see Figure 10).
The following results were obtained for the percentage climbing success and mean climbing
times in seconds from this study:
• 48 in (122 cm) fence height – there was a statistically significant difference in
children’s ability to climb the 48 in (122 cm) fence designs (Chi-square (4) = 73.7, p<
0.001).
o For the 24-36 months age group, the large chain-link fence was the easiest
fence to climb (83 percent success, an average of 22.9 seconds) and this was
easier to climb than small chain-link fence (17 percent success, an average of
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15 seconds). No child in this age range was able to climb the picket, stockade
or ornamental iron fence.
o For the 36-42 months age group, the large chain-link fence was the easiest
fence to climb (85 percent success, an average of 11.5 seconds) and this was
easier to climb than small chain-link fence (62 percent success, an average of
18.1 seconds). No child in this age range was able to climb the picket,
stockade or ornamental iron fence.
o For the 42-48 months age group, the large chain-link fence was the easiest
fence to climb (92 percent success, an average of 8.7 seconds) and this was
easier to climb than small chain-link fence (75 percent success, an average of
10.1 seconds). One-quarter of children at this age were able to climb the
stockade (25 percent success, an average of 25.3 seconds). A few children in
this age range were able to climb the picket (8 percent success, an average of
16 seconds) or ornamental iron fence (8 percent success, an average of 76
seconds). Results confirmed that at 48 in (122 cm) the ornamental iron fence
was the hardest to climb.
• 54 in (137.2 cm) fence height – there was a statistically significant difference in
children’s ability to climb the 54 in (137.2 cm) fence designs (Chi-square (4) = 63.5,
p< 0.001).
o For the 24-36 months age group, the large chain-link fence was the easiest
fence to climb (65 percent success, an average of 22.7 seconds) and this was
easier to climb than small chain-link fence (4 percent success, an average of
51 seconds). No child in this age range was able to climb the picket, stockade
or ornamental iron fence.
o For the 36-42 months age group, the large chain-link fence was the easiest
fence to climb (92 percent success, an average of 15.1 seconds) and this was
easier to climb than small chain- link fence (15 percent success, an average of
25 seconds). No child in this age range was able to climb the picket, stockade
or ornamental iron fence.
o For the 42-48 months age group, the large chain-link fence was the easiest
fence to climb (92 percent success, an average of 11.8 seconds) and this was
easier to climb than small chain-link fence (67 percent success, an average of
20 seconds). Less than one quarter of children at this age were able to climb
the stockade (17 percent success, an average of 12.5 seconds). A few children
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in this age range were able to climb the picket (8 percent success, an average
of 15 seconds). No children were able to climb the ornamental iron fence.
Results confirmed that at 54 in (137.2 cm) the ornamental iron fence could
not be climbed by children in the ages tested.
• 60 in (152.4 cm) fence height – there was a statistically significant difference in
children’s ability to climb the 60 in (152.4 cm) fence designs (Chi-square (4) = 63.5,
p< 0.001).
o For the 24-36 months age group, the large chain-link fence was the easiest
fence to climb (65 percent success, an average of 23.5 seconds) and this was
easier to climb than small chain-link fence (4 percent success, an average of
20 seconds). No child in this age range was able to climb the picket, stockade
or ornamental iron fence.
o For the 36-42 months age group, the large chain-link fence was the easiest
fence to climb (92 percent success, an average of 15.2 seconds) and this was
easier to climb than small chain-link fence (15 percent success, an average of
17 seconds). No child in this age range was able to climb the picket, stockade
or ornamental iron fence.
o For the 42-48 months age group, the large chain-link fence was the easiest
fence to climb (92 percent success, an average of 11.6 seconds) and this was
easier to climb than small chain-link fence (67 percent success, an average of
20 seconds). Less than one-quarter of children at this age were able to climb
the stockade (17 percent success, an average of 17 seconds). A few children
in this age range were able to climb the picket (8 percent success, an average
of 42 seconds). No children were able to climb the ornamental iron fence.
Results confirmed that at 60 in (152.4 cm) no children in the ages tested were
able to climb the ornamental iron fence.
These results are summarized for climbing success in Figure 20 and for climbing time in
Figure 21. There were no significant differences in climbing success between boys and girls
for any of the fence designs. When children were able to use some other part of the platform
structure to assist with climbing then success rates for the ornamental iron fence were
13 percent (24-36 months), 8 percent (36-42 months), 25 percent (42-48 months) and
100 percent (48-54 months). However, results consistently showed that the ornamental iron
fence was the hardest design to climb unassisted and that when children were successful
then usually it took the longest to climb.
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Results from these three studies show that fence design and children’s age, and sometimes
children’s gender, all influence climbing success. Although more boys are involved in
submersion incidents in swimming pools, the results of this study did not show that boys
were better climbers than girls for the ages tested. In general, the study found little evidence
of significant gender differences in ability to climb the fences.
Figure 20
Age and Fence Height Effects on Climbing Success
(plotted from Rabinovich et al., 1994)
The results clearly showed that chain-link fences can most easily be climbed, especially when
this is a large-aperture chain-link (2.5 in, 6.35 cm). Even in the youngest group
(24-36 months), 75 percent of children were able to climb a 48 in (122 cm) high large chainlink fence and 13 percent could climb a small chain-link fence. Even with the roller and
angled plate top treatments, the 48 in (122 cm) high large chain-link fence was easy for
children age 36-48 months to climb.
Apart from the chain-link designs, the young children aged 24-36 months were unable to
climb any of the other fence designs in the allotted time. However, for the three older
groups (36 to 42 months, 42 to 48 months, and 48 to 54 months), at least some of the
children could climb all of the fences at a 48 in (122 cm) height, with the possible exception
of the ornamental iron fence where this was only climbed with the use of the platform
structure to assist with climbing.
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Figure 21
Age and Fence Height Effects on Climbing Speed
(plotted from Rabinovich et al., 1994)
Results for the stockade fence design were mixed. In study 1, children younger than
42 months were unable to climb the stockade fence, but 17 percent of those aged
42-48 months and 33 percent of those aged 48-54 months were able to climb this design. In
study 2, 14.1 percent of children 36-42 months and 12 percent of children 42-48 months
were able to climb the stockade, and even when the top angle plate was added, 14.6 percent
of those aged 42-48 months were able to climb the stockade. None of the children were able
to climb the stockade with roller top treatment.
In all studies the ornamental iron fence was the most difficult design to overcome (with the
exception of the stockade with the angled plate for the children in the oldest group). The
48 in (122 cm) high ornamental iron fence could not be climbed by children younger than
42 months and either the addition of the roller top or the top angle plate, or raising the fence
height to 54 in (137.2 cm) or 60 in (152.4 cm) made this design unclimbable by children aged
42-48 months. Even when it was climbed, the climbing time almost invariably was longest
for the ornamental iron fence design. The ornamental iron fence consistently was the most
difficult to climb on all measures and the authors note that this may be an especially good
choice because, in addition to being difficult to climb, it also affords excellent vision through
the fence, which can improve supervision.
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Fence Design – Dutch Research
Research in the Netherlands (Jaartsveld, ten Wolde and van Aken, 1995) has tested the
effects of three different rail fence heights: 31.5 in (80 cm); 39.4 in (100 cm); and 47.2 in
(120 cm) for a 2 in (5 cm) diagonal chain-link fence with rigid posts and a top rail, and at a
39.4 in (100 cm) height, the effects of four other different fence designs:
• Line - Diagonal chain-link - 2 in (5 cm), with rigid posts and a top wire
• Flex - Diagonal chain-link - 2 in (5 cm), with flexible posts and a top wire
• Bar - 1 in (2.6 cm) diameter bars spaced at 5.9 in (15 cm)
• Panel - welded steel wires with a mesh size of 2 in (5 cm) x 7.9 in (20 cm)
A total of 66 children (31 boys and 35 girls) aged between 2.5 and 6 years of age participated
in the study. Children were asked to climb over the fence starting with the lowest fence
height. An experimenter was positioned either side of the fence to prevent the child from
falling. The youngest children, aged 2.5 to 3 years, were asked to retrieve a ball that was
positioned behind the fence.
Results from the study showed a statistically significant effect of age: the older the child the
greater the chance of climbing success and the faster the climb over the fence (r = 0.5,
p<0.001). There was also a statistically significant effect of height for the panel fence and for
the different heights of the rail fence, and taller children surmounted these obstacles more
quickly than shorter children (r = 0.53, p<0.01).
Technique was important for climbing the bar fence, where children who succeeded jumped
up to support themselves with their hands. Shoe style was important, and children wearing
wider shoes had significantly greater difficulty climbing the chain-link fences (F=3.05,
p=0.02). There was no effect of clothing.
The experimental apparatus is shown in Figure 22.
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Figure 22
Experimental Apparatus
(redrawn from Jaartsveld et al., 1995)
Results for the effects of age on the percent climbing success for the three different rail
fence heights are shown in Figure 23, and those for the five different fence designs at a 39.4
in (100 cm) height are shown in Figure 24. The height of the rail chain-link fence had a
significant effect on climbing success for those under 36 months of age; otherwise it was not
very effective in the range tested as an obstacle to climbing. The chain-link fence was easy to
climb because the apertures in the mesh worked well as footholds and handholds. The flex
fence was harder to climb, especially for the children younger than 42 months. The bar fence
was effective in preventing children under 48 months from successfully climbing the fence.
With this design it is important that the horizontal spacing of the bars is less than 4 in
(10 cm) to prevent younger children from squeezing between the bars.
Figure 23
Age and Height Effects on Climbing Success for the Rail Fence
(plotted from Jaartsveld et al., 1995)
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The panel fence was effective in stopping younger children from climbing but older children
were able to surmount this design. The authors conclude that a vertical bar fence design is
the most effective design overall, that this should be at least 39.4 in (100 cm) high, and that
any supports, corner posts or horizontal elements or wires should be situated on the far side
of the fence so that children cannot use these as a stepping aid to climb over the fence.
Figure 24
Age and Fence Design Effects on Climbing Success at a 39.4 in (100 cm) Height
(plotted from Jaartsveld et al., 1995)
Fence Design – NZ Research
The New Zealand Building Code calls for barriers that guard a change in elevation to be
designed to restrict the passage of children less than 6 years of age. The typical barrier on a
New Zealand house deck or balcony is 39.4 in (100 cm), and designs do not have toeholds
between 5.9 in (15 cm) and 30 in (76 cm) height. To test the effectiveness of different barrier
designs, a test was conducted on a small sample of 19 children (11 boys, 8 girls) aged from
15 months to 5 years who were asked to try to climb a series of 10 barriers of different
design and construction (Alchemy Engineering & design, 2002). Two boys were aged from
15-21 months, five children were 2 years old (4 boys, 1 girl), four were 3 years old (3 boys, 1
girl), seven were 4 years old (1 boy, 6 girls), and one girl was 5 years old. The gender
breakdown was not given for the different age ranges. All barriers were made of metal (nine
aluminum, one stainless steel). All test barriers were 47.24 in (120 cm) wide but their height
and configurations were varied.
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Table 9
Barrier Designs and Test Results
(Alchemy Engineering & Design, 2002)
Test Barriers
% Climbing Success
(success/total attempts+no attempts)
(# successes/# failures/ # no attempts)
2 yrs
3 yrs
4 yrs
5 yrs
Image
1A – 1m high. Horizontal
infill members with spacing
<= 10cm. Plated barrier top
with inward return (20.5 cm
from top, 15cm underneath)
40%
(2/2/1)
75%
(3/0/1)
100%
(7/0/0)
100%
(1/0/0)
1B – same as 1A but
reversed.
60%
(3/1/1)
75%
(3/0/1)
100%
(7/0/0)
100%
(1/0/0)
1C – same as 1A but top rail
replaced by centrally located
rail 7cm wide.
80%
(4/0/1)
75%
(3/0/1)
100%
(7/0/0)
100%
(1/0/0)
2A – 81cm high with solid
plywood infill. Centered top
rail centrally (20cm wide x
5.5cm thick).
0%
(0/2/3)
0%
(0/1/3)
100%
(7/0/0)
100%
(1/0/0)
2B – same as 2A but top rail
replaced with centered rail
7cm wide.
0%
(0/2/3)
50%
(2/0/2)
100%
(7/0/0)
100%
(1/0/0)
3A – 1m high. Perforated
aluminum panel (3cm
square, 4cm diagonal)
0%
(0/2/3)
25%
(1/1/2)
43%
(3/2/2)
0%
(0/1/0)
4A – 90cm high vertical tube
balustrade with 10cm
spacing. Horizontal rail 10cm
from ground.
0%
(0/1/4)
0%
(0/2/2)
86%
(6/1/0)
100%
(1/0/0)
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Test Barriers
% Climbing Success
(success/total attempts+no attempts)
(# successes/# failures/ # no attempts)
2 yrs
3 yrs
4 yrs
5 yrs
Image
4B – same as 4A but 1m
high.
0%
(0/1/4)
0%
(0/2/2)
71%
(5/2/0)
0%
(0/1/0)
4C – same as 4A but 1.1m
high.
0%
(0/1/4)
0%
(0/2/2)
57%
(4/3/0)
0%
(0/1/0)
5 – Stair balustrade, 1m
high, 34° slope. Vertical
posts 1.2m apart. Wire infill
spaced at 9.5cm, parallel to
5cm top handrail.
0%
(0/1/4)
0%
(0/2/2)
86%
(6/0/1)
100%
(1/0/0)
Results of this study showed that children under the age of 2 years or less were not
physically mature or strong enough to climb any of the barriers that were tested. Between
40 percent and 80 percent of the children aged 2 years were able to climb the barriers that
had the horizontal rails, but were unable to climb any other barrier design. Seventy-five
percent of the 3-year-old children were able to climb the barriers with horizontal rails,
50 percent were able to climb the solid barrier with a narrow top rail, and 25 percent were
able to climb the perforated aluminum panel, but the children were unable to climb any of
the other designs. All of the 4-year-old children were able to climb the barriers with the
horizontal rails and those with the solid barrier, and 43 percent were able to climb the
perforated aluminum barrier. Eighty-six percent of the 4-year olds were able to climb the
barrier with vertical elements when this was 35.4 in (90 cm), 71 percent when it was 39.4 in
(100 cm) high, and 53 percent when it was 43.3 in (110 cm) high. The 5-year-old child was
able to climb all of the barriers except for the perforated aluminum and the 39.4 in (100 cm)
and 43.3 in (110 cm) barriers with vertical elements. The researchers noted that when the
barriers had wide tops those children who succeeded in climbing tended to stand on these
and then jump off. The 39.4 in (100 cm) and 43.3 in (110 cm) barriers with the vertical
elements were judged to be the most effective barrier designs. Although this particular study
suffers from a small number of test children, the findings generally agree with the results
obtained by Rabinovich et al. (1994) and Jaartsveld et al., 1995).
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Swimming Pool Fencing
In the United States, accidental drowning is the third leading cause of death among children
aged 1 to 4 years, and in California, Arizona, and Florida it is the leading cause of death
(Morgenstern, Bingham, and Reza, 2000). A two-stage study was undertaken in Los Angeles
County, California, to evaluate the impact of local pool-fencing ordnance (ibid.) In stage one,
estimates for the number of children younger than 10 years who died from drowning in a
swimming pool in the period 1990 through 1995 were compiled. In stage two, for each case
swimming pools and control swimming pools without a drowning incident were randomly
selected from all pools built before 1996 and whether or not the pool was fenced was noted.
The results of stage one identified 146 childhood drowning incidents which represent an
annual incidence of pool drowning of 1.77/100,000. The drowning rate was almost 10 times
higher in toddlers (1-4 years) and almost three times higher in boys than girls. Surprisingly,
results from stage two showed that the overall drowning rate was not lower in pools that had
fencing, indeed, 81 percent of all drowning occurred in pools that had fencing. Overall, the
results suggest that the pool fencing ordinance enacted in Los Angeles County has not been
effective in reducing the incidence of childhood drowning in residential swimming pools.
There are several reasons why pool fencing may be ineffective—in order to drown, children
have to already be in the pool. If children are left unsupervised, the presence or absence of
fencing will not adjust the risk of drowning, or children may be able to climb the pool
fencing. Ridenour (2001) investigated children’s climbing skills when faced with the side of
an above-ground swimming pool wall. The study tested 15 children (42-54 months) who
were asked to attempt to climb a 48 in (122 cm) swimming pool wall. The average height of
the sampled children was 42 in (106.7 cm) and the range was from a minimum of 39 in
(99.1 cm) to a maximum of 43 in (109.2 cm). The children were asked to attempt to climb
over the pool wall in three conditions: without any aid, with adjacent pool filter 12 in
(30.5 cm) from the wall, and with the safety ladder frame in place. The order of these
conditions was randomized during testing. Results showed that six of the 15 children failed
to climb the pool wall in any condition; five of 15 children were able to climb the pool wall
without any aid; and four children were able to climb the wall with the use of an aid (three
used the pool filter and one used the safety ladder frame). The height and age of child did
not affect their climbing success; however, their climbing technique was important.
Techniques for climbing the swimming pool wall in each of the three conditions are
illustrated in Figure 25, Figure 26, and Figure 27. The 48 in (122 cm) wall of the home
swimming pool did not consistently function as an effective barrier to climbing, and
consequently the author recommends the use of additional pool fencing and constant
supervision to prevent children from accidentally entering above-ground home swimming
pools.
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Figure 25
Typical Movement Pattern of a Child Climbing Over the Pool Wall
(Ridenour, 2001)
Figure 26
Typical Movement Pattern of a Child Climbing Over the Pool Wall
with the Aid of the Pool Filter
(Ridenour, 2001)
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Figure 27
Typical Movement Pattern of a Child Climbing Over the Pool Wall
with the Aid of the Safety Ladder Frame
(Ridenour, 2001)
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Conclusions
Evidence has been reviewed showing that climbing is an inevitable and integral part of
childhood development. Climbing is involved in the child’s physical, psychological, and
social development. Climbing skills are often taught and encouraged by parents, especially
with boys, and climbing is a part of physical education at school. The literature identifies
many factors that affect a child’s propensity to climb and their climbing prowess. Among
young children less than 5 years old there is no evidence of a significant difference between
boys and girls in either their climbing skill or their climbing speed. However, early
socialization process encourage greater caution in young girls while greater risk taking is
tolerated and sometimes celebrated in young boys. By the age of 5 years most children will
attempt to climb almost any barrier and many will succeed. The success with which climbing
occurs will depend on a variety of factors that relate to the child and also a variety of factors
that relate to the design of the area that is being climbed, and these have been discussed in
the report (see Figure 28).
Figure 28
Some Factors that Influence a Child’s Climbing Ability
Much of the research that has been conducted has focused on window falls in young
children, and most of the studies have been conducted using incidents that occurred without
window guards. Estimates of the incidence of falls vary widely between studies and this is
probably because the national estimates that are computed are based on a limited number of
local samples of injuries. Virtually all of these studies have focused on the nature of the
injuries and on the general category of the fall (e.g., window, stair) and they have neglected
specific design details of where and how the incident occurred. The New York City
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legislation on window guards has produced a dramatic decrease in childhood falls through
open windows.
A few studies have also looked at falls from balconies. In these studies the balconies mostly
have been in low-income older housing stock that was built long before the current building
code for balconies was enacted. None of the studies contain any details of the design and
construction of the balconies or the circumstances whereby a fall occurred (e.g., did the child
fall through the rails, did they climb over the balcony, did they use another object to aid
climbing). Moreover, the published studies of balcony falls have examined data collected
prior to the current 4 in (10 cm) rail spacing requirement and to date not a single research
study has evaluated the impact that the current building code has had on reducing the
incidence of falls, for example, the potentially protective effect of setting the spacing of
vertical elements to exclude a 4 in (10 cm) sphere.
Studies also generally agree that it is probably impossible and most likely undesirable to
render any environment completely “safe” from children’s climbing. There can be situations
in which children do need to climb over a barrier to escape. It is questionable whether the
design of a barrier alone can determine children’s behavior. As studies of swimming pool
fencing show, even when extreme measures have been taken to prevent climbing children
will still use other objects or devise unusual ways of climbing a barrier. It may be impractical
to create a barrier that children cannot climb; however, it is possible to encourage designs
that discourage climbing in locations that are potentially hazardous. The climbability of any
structure is affected by the barrier height, the size, and distance between any horizontal and
vertical supports, the smoothness and shape of the supports, and that materials used to
construct the barrier. Higher barriers with fewer smoother, rounded horizontal supports,
preferably metal, and placed at greater vertical distances will be more difficult to climb
because of the difficulty of using the supports as a foot or handhold. This is why the choice
of materiality is essential when considering objects that come in touch with children.
Climbing simulation studies have been conducted in several countries to determine the
design details that either facilitate or impair a young child’s ability to climb. In these studies,
various fence designs have been tested but the nomenclature used has been inconsistent and
it is not always clear precisely what the physical design attributes were. Some of these studies
have used exceedingly small numbers of children, making statistical analysis impossible, and
while those studies conducted in the United States generally have tested respectable numbers
of children, all have focused on testing swimming pool fencing rather than balcony guard
rails. Unfortunately, none of the studies has adopted a truly naturalistic approach where
children are observed without them being aware of this. In the studies that have been
conducted, especially those of fencing designs, none has investigated whether the presence
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of horizontal bars serves to encourage a child to climb has or not. In all of the research
studies, the children have been encouraged by adults to try to climb whatever was being
tested and, in some instances, up to three adults have been present to provide such
encouragement and to help to catch the child should s/he actually fall. When children have
climbed a structure, generally the researchers have gone to considerable lengths to provide
substantial padding to cushion any fall. Thus, all studies have essentially removed any “fear
factor” from their research, and consequently the results may not translate directly to reality
where encouraging adults and cushioned surfaces generally are absent. From the studies
reviewed in this report, it is possible to generally identify the design factors that either
facilitate or inhibit climbing (Table 10). Some studies have looked at children climbing
ladders and the results show that vertical ladders are more discouraging than angled ladders.
Other studies of fence designs agree that for a barrier to be unclimbable by a young child
under 4 years of age this has to be at least 55.1 in (140 cm) high and made of vertical
rounded metal rails, but such a design is impractical in many situations.
Table 10
Some Design Details that Affect the Ease of Climbing a Barrier
Facilitating Design Elements
Low barrier height (less than 39.4 in (100 cm)
Easily graspable top rail
Horizontal rails spaced to serve as rungs
Openings to flat surfaces that serve as stable footholds
Inhibiting Design Elements
Higher barrier height (39.4 in [100 cm] plus)
Top rail that is difficult to grasp, and not broad enough
for a child to stand on
Horizontal rails with very close or very wide spacing
Vertical rails
Openings that are too small for footholds
Steeply angled surfaces
Most of the simulation studies reviewed note the inherent limitation of only addressing the
physical design of a barrier as one component in the etiology of children’s falls, and many
also suggest that a comprehensive safety education program for young children, especially
during the warmer months, is desirable and likely to have the greatest impact on minimizing
the incidence of falls. Given the wide variation in the scope, methodology, and quality of the
research studies on climbing that have been conducted and that are included in this report
and the lack of scientific testing of specific design alternatives, it is premature to use the
research studies that have been reviewed as the basis for any code requirements for the
design and construction of balcony guard rails.
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Page, M., Powell, L., Wilson, M. & E. Ward (1995) The Development of Safety Criteria
for Specifying the Performance of Children's Safety Barriers. Proceedings of the 3rd
International Conference on Product Safety Research, Amsterdam, 6-7 March 1995,
Edited by W. van Weperen. CIP-Gegevens Koninklijke Bibliotheek, The Hague, 1–19.
Pressley, J.C. & B. Barlow. (2005) Child and adolescent injury as a result of falls from
buildings and structures. Injury Prevention, 11, 267-273
Rabinovich, B.A., Lerner N.D., and R. W. Huey. (1994) Young Children's Ability to Climb
Fences. Human Factors, 36 (4), 733-744.
Readdick C.A. & J.J. Park. (1998) Achieving great heights: The climbing child. Young
Children, 53 (6), 14-19.
Ridenour, M.V. (2001) Climbing performance of children: Is the above-ground pool wall a
climbing barrier? Perceptual and Motor Skills, 92 (3 Pt. 2), 1255-1262.
Ridenour, M.V. (2002) How do children climb out of cribs? Perceptual and Motor Skills,
95 (2), 363-366.
Riley, J.E., Roys M.S. & S.M. Cayless. (1998) Initial assessment of children's ability to
climb stair guarding. The Journal of the Royal Society for the Promotion of Health.
118(6) 331-337.
Sanders, M.M. & E.J. McCormick. (1993) Human Factors in Engineering & Design
7th ed., McGraw-Hill, NY.
Sklet, S. (2006) Safety barriers: Definition, classification, and performance. Journal of
Loss Prevention in the Process Industries, 19, 494-506.
Small, M.Y. (1990) Cognitive Development. San Diego: Harcourt Brace Jovanovich Inc.
Publishers.
Snyder, R.G., Spencer, M.L. & C.J. Owings. (1975) Physical Characteristics of Children
as Related to Death and Injury for Consumer Product Design and Use. Highway Safety
Research Institute, University of Michigan, May 31. UM-HSRI-BI- 75-5 Final Report.
240 pages.
Snyder, R.G., Schenider, L.W., Owings, C.L., Reynolds, H.M., Golomb, D.H. & M.A.
Schork. (1977) Anthropometry of Infants, Children and youths to Age 18 for Product
Safety Design. Highway Safety Research Institute, University of Michigan, May 31. UMHSRI- 77-17 Final Report. 648 pages.
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Testa, M. Martin, L. & B. Debû. (2003) 3D analysis of posture-kinetic coordination
associated with a climbing task in children and teenagers. Neuroscience Letters, 336,
45-49.
van Herrewegen, J., Molenbroek, J. & H. Goossens. (2004) Children’s Climbing Skills,
ANEC Report, November. 42 pages.
van Herrewegen, J. & J. Molenbroek. (2005) Practical Test “Children and Ladders”,
ANEC Report. November. 59 pages.
Vish, N.L., Powell, E.C., Wiltsek, D. & K.M. Sheehan. (2005) Pediatric window falls: not
just a problem for children in high rises. Injury Prevention, 11, 300-303.
Wang, M.Y., Kim, K.A., Griffith, P.M., Summers, S., McComb, J.G., Levy, M.L. & G.H.
Mahour. (2001) Injuries from falls in the pediatric population: An analysis of 729 cases
Journal of Pediatric Surgery, 36 (10), 1528-1534.
Wood, D. J. (1998). How Children Think and Learn: The Social Contexts of Cognitive
Development. Blackwell Publishing
Additional Sources of Anthropometric Data for Children
Norris, B.J. & J. R. Wilson. (1995) Childata: the handbook of child measurements and
capabilities: data for design safety. London: Department of Trade and Industry
Pheasant, S. & C.M. Haslegreave. (2006) Bodyspace: Anthropometry, ergonomics and
the design of work, 3rd ed. London, Taylor & Francis.
Roebuck Jr., J.A. (1995) Anthropometric methods: Designing to fit the human body,
Chapanis, A. (Series ed.) Monographs in human factors and Ergonomics, Santa Monica,
Ca. Human Factor and Ergonomics Society.
Tilley, A.R. & Henry Dreyfuss Associates (2002) The measure of Man and Woman:
Human Factors in Design, John Wiley & Sons Inc., New York.
Additional Publications
Leto, T. (2000) The Ladder Effect. Ornamental & Miscellaneous Metal Fabricator,
July/August, p.60.
Stephenson, E.O. (1999) Climbable guards: an unnecessary hazard to children.
Southern Building, May/June, 4, 6.
Stephenson, E.O. (2002) Climbable guards: the special enemy of the world’s 2- and 3year-old children. The Code Official, BOCA International Inc., 36-41.
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Appendix A
Excerpts of Provisions on Guards
from National Model Building Codes
I.
Introduction
This is a summary of building code requirements for Guards and Guardrails for the
United States, Canada, and Australia. Excerpted provisions are relevant sections of the
referenced codes that relate to specifications for guards. A statement of scope, definition
of terms and applicability are provided for context. Provisions that reference “facilitate
climbing,” “climbability,” or “ladder effect” are highlighted in bold, italic font and
underlined.
Codes reviewed are as follows:
•
International Residential Code (IRC 2000, 2003, and 2006) published by the
International Code Council (ICC)
•
International Building Code (IBC 2000, 2003, and 2006) published by the
International Code Council (ICC)
•
International One- and Two-Family Dwelling Code (1998) published by the
International Code Council (ICC)
•
One and Two Family Dwelling Code (CABO 1992 and 1995) published by the
Council of American Building Officials (CABO)
•
Uniform Building Code (UBC 1991 - 1997) published by International
Conference of Building Officials (ICBO)
•
Standard Building Code (SBC 1991 - 1997) published by Southern Building
Code Congress International (SBCCI)
•
National Building Code (BOCA 1990, 1993, and 1999) published by the Building
Officials and Code Administrators International (BOCA)
•
Canadian Housing Code (CHC 1990, Rev. Jan 1994) published by National
Research Council of Canada (NRC-CNRC)
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•
National Building Code of Canada (NBC 1990 and 2005) published by National
Research Council of Canada (NRC-CNRC)
•
Building Code of Australia (BCA 2005) published by Australian Building Codes
Board
•
Building Code of New Zealand (BNZ 2007) published by Department of Building
and Housing, New Zealand
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II.
BUILDING CODES WITH CLIMBABILITY, CLIMBING, OR LADDER EFFECT
A.
INTERNATIONAL RESIDENTIAL CODE
INTERNATIONAL RESIDENTIAL CODE 2000 Edition
SECTION R101
TITLE, SCOPE AND PURPOSE
R101.2 Scope. The provisions of the International Residential Code for One- and TwoFamily Dwellings shall apply to construction, alteration, movement, enlargement,
replacement, repair, equipment, use and occupancy, location, removal and demolition of
detached one- and two-family dwellings and multiple single-family dwellings
(townhouses) not more than three stories in height with a separate means of egress and
their accessory structures.
SEC. R202
DEFINITIONS
Guard. A building component or a system of building components located near the open
sides of elevated walking surfaces that minimizes the possibility of a fall from the walking
surface to the lower level.
Deck. An exterior floor supported on at least two opposing sides by an adjacent
structure, and /or post, piers or other independent supports.
Balcony, Exterior. An exterior floor projecting from and supported by a structure without
additional independent supports.
Porch. No Definition Given in 2000 or 2006 IRC
SEC. R316
GUARDS
R316.1 Guards required. Porches, balconies, or raised floor surfaces located more
than 30 inches (762 mm) above the floor or grade below shall have guards not less than
36 inches (914 mm) in height. Open sides of stairs with a total rise of more than
30 inches (762 mm) above the floor or grade below shall have guards not less than
34 inches (864 mm) in height measured vertically from the nosing of the treads.
R316.2 Guard opening limitations. Required guards on open sides of stairways, raised
floor areas, balconies and porches shall have intermediate rails or ornamental closures
that do not allow passage of a sphere 4 inches (102 mm) in diameter. Required guards
shall not be constructed with horizontal rails or other ornamental pattern that
results in a ladder effect.
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INTERNATIONAL RESIDENTIAL CODE 2003 Edition
R312.1 Guards required. Porches, balconies, or raised floor surfaces located more
than 30 inches (762 mm) above the floor or grade below shall have guards not less than
36 inches (914 mm) in height. Open sides of stairs with a total rise of more than
30 inches (762 mm) above the floor or grade below shall have guards not less than
34 inches (864 mm) in height measured vertically from the nosing of the treads.
Porches and decks which are enclosed with insect screening shall be provided with
guards where the walking surface is located more than 30 inches (762mm) above the
walking surface.
R316.2 Guard opening limitations. Required guards on open sides of stairways, raised
floor areas, balconies and porches shall have intermediate rails or ornamental closures
that do not allow passage of a sphere 4 inches (102 mm) or more in diameter.
Exceptions:
1. Triangular Openings formed by the riser, tread and bottom rail of a guard at the
open side of a stairway are permitted to be of such a size that sphere 6 inches
(152mm) cannot pass through.
2. Openings for required guards on the sides of stair treads shall not allow a sphere
4 3/8 inches (107mm) to pass through.
INTERNATIONAL RESIDENTIAL CODE 2006 Edition
R312.1 Guards required. Porches, balconies, ramps or raised floor surfaces located
more than 30 inches (762 mm) above the floor or grade below shall have guards not less
than 36 inches (914 mm) in height. Open sides of stairs with a total rise of more than
30 inches (762 mm) above the floor or grade below shall have guards not less than
34 inches (864 mm) in height measured vertically from the nosing of the treads.
Porches and decks which are enclosed with insect screening shall be provided with
guards where the walking surface is located more than 30 inches (762mm) above the
walking surface.
R316.2 Guard opening limitations. Required guards on open sides of stairways, raised
floor areas, balconies and porches shall have intermediate rails or ornamental closures
that do not allow passage of a sphere 4 inches (102 mm) or more in diameter.
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Exceptions:
1. Triangular Openings formed by the riser, tread and bottom rail of a guard at the
open side of a stairway are permitted to be of such a size that sphere 6 inches
(152mm) cannot pass through.
2. Openings for required guards on the sides of stair treads shall not allow a sphere
4 3/8 inches (107mm) to pass through.
B.
BOCA NATIONAL BUILDING CODE (BOCA 1993 & 1999)
SECTION 406.0
OPEN PARKING STRUCTURES:
406.5 Guards: All open-sided floor areas shall be provided with a guard in
accordance with Section 1021.0
SECTION 408.0
PUBLIC GARAGES:
408.3.2 Roof storage of motor vehicles: Where the roof of a building is
occupied for the parking or storage of motor vehicles, such roof shall be provided with a
parapet wall or a guard constructed in accordance with Section 1021.0
SECTION 1005.0
GENERAL LIMITATIONS
1005.5 Open-Sided Floor Areas: Guards shall be located along open-sided
walking surfaces, mezzanines, and landings which are located more than
30 inches (762 mm) above the floor or grade below. The guards shall be
constructed in accordance with Section 1021.0
SECTION 1016.0
RAMPS
1016.5 Guards and handrails: Guards shall be provided on both sides of the
ramp and shall be constructed in accordance with Section 1021.0.
SECTION 1825.0
RETAINING WALLS
1825.5 Guards: Where retaining walls with differences in grade level on either
side of the wall in excess of 4 feet (1219 mm) are located closer than 2 feet
(610 mm) to a walk, path, parking lot or driveway on the high side, such retaining
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walls shall be provided with guards that are constructed in accordance with
Section 1021.0 or other approved protective measures.
SECTION 502.0
DEFINITIONS
Mezzanine. An intermediate level or levels between the floor and ceiling of any
story with an aggregate floor area of not more than one-third of the area of the
room in which the level or levels are located.
Balcony, Deck, Porch. No Definition Given in 1993 BOCA
SECTION 1021.0
GUARDS
1021.1 General: Where required by the provisions of Sections 406.5 …... and
1825.5, guards shall be designed and constructed in accordance with the
requirements of this section and Section 1615.8. A guardrail system is a system
of building components located near the open sides of elevated walking surfaces
for the purpose of minimizing the possibility of an accidental fall from the walking
surface to the lower level.
1021.3 Opening limitations: In occupancies in Use Group A, B, E, H-4,I-1, I-2,
M and R, and in public garages and open parking structures, open guards shall have
balusters or be of solid material such that a sphere with a diameter of 4 inches (102 mm)
cannot pass through any opening. Guards shall not have an ornamental pattern that
would provide a ladder effect.
C.
INTERNATIONAL ONE-AND TWO-FAMILY DWELLING CODE (IOTFDC 1998)
SECTION 102
SCOPE
103.1 Application. The provisions of this code apply to the construction,
addition, prefabrication, alteration, repair, use, occupancy and maintenance of detached
one- and two- family dwellings and one-family townhouses not more than three stories
in height, and their accessory structures.
SECTION 202
GENERAL BUILDING DEFINITIONS
Balcony (Exterior). An exterior floor system projecting from a structure and
supported by that structure, with no additional independent supports.
Deck. An exterior floor system supported on at least two opposing sides by an
adjoining structure and/or posts, piers, or other independent supports.
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Guardrail System. A system of building components located near open sides of
elevated walking surfaces.
Porches are not defined in the 1998 IOTFDC.
SECTION 315 HANDRAILS AND GUARDRAILS
315.3 Guardrail details. Porches, balconies or raised floor surfaces located
more than 30 inches (762 mm) above the floor or grade below shall have
guardrails not less than 36 inches (914 mm) in height. Open sides of stairs with a
total rise of more than 30 inches (762 mm) above the floor or grade below shall
have guardrails not less than 34 inches (864 mm) in height measured vertically
from the nosing of the treads.
315.4 Guardrail opening limitations. Required guardrails on open sides of
stairways, raised floor areas, balconies and porches shall have intermediate rails
or ornamental closures which do not allow passage of an object 4 inches
(102 mm) or more in diameter. Required guards shall not be constructed with
horizontal rails or other ornamental pattern that results in a ladder effect.
D.
CANADIAN HOUSING CODE (CHC 1990, Revised 1994)
Part 1
Scope and Definitions
Section 1.1.2 Scope
1.1.2.2.
(1) This Code applies to the construction of detached, semi-detached and row
houses, together with their ancillary private storage garages, provided such houses
(a)
have no shared egress facilities,
(b)
have no dwelling unit above or below them,
(c)
have no shared service spaces, service shafts or service rooms,
(d)
are self-contained with respect to heating and ventilation,
(e)
have a building area not greater than 600 m2 (6456 ft2), and
(f)
have a building height of not more than 3 storeys.
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(2) Houses other than those described in Sentence (1) shall conform to the
National Building Code of Canada 1990.
Section 1.1.3 Definitions of Words and Phrases
Mezzanine means an intermediate floor assembly between the floor and ceiling
of any room or storey and includes an interior balcony.
Landing, Porch, and Gallery are not defined in CHC 1990.
Part 9
Housing
Section 9.8
Stairs, Ramps, Handrails and Guards
9.8.8. Guards
9.8.8.1. Required Guards
(1) Every exterior landing, porch and every balcony, mezzanine, gallery,
raised walkway and roof to which access is provided for other than maintenance
purposes, shall be protected by guards on all open sides where the difference in
elevation between adjacent levels exceeds 600 mm (23.6 in).
(2) Every exterior stair with more than 6 risers shall be protected with
guards on all open sides where the difference in elevation between the adjacent
ground level and the stair exceeds 600 mm (23.6 in).
(3) When an interior stair has more than 2 risers, the sides of the stair and
the landing or floor level around the stair well shall be enclosed by walls or be
protected by guards, except that a stair to an unfinished basement in a dwelling unit
may have one unprotected side.
9.8.8.5 Design to Prevent Climbing. Guards around exterior balconies shall
be designed so that no member, attachment or opening between 100 mm
(3.9 in) and 900 mm (35.4 in) above the balcony floor will facilitate climbing.
E.
NATIONAL BUILDING CODE OF CANADA (NRC-NBC 1990, Revised 1991)
Part 1 Scope and Definitions
Section 1.1.3. Definitions of Words and Phrases
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Guard means a protective barrier around openings in floors or at the open sides
of stairs, landings, balconies, mezzanines, galleries, raised walkways or other locations
to prevent accidental falls from one level to another. Such barrier may or may not have
openings through it.
Mezzanine means an intermediate floor assembly between the floor and ceiling
of any room or storey and includes an interior balcony.
Landings, Balconies, and Galleries are not defined in NRC-NBC 1990
Part 3
Use and Occupancy
Section 3.3.1. Requirements Applying to All Floor Areas
Section 3.3.1.17. Guards.
(1) A guard not less than 1070 mm (42 in) high shall be provided
(a) around each roof to which access is provided for other than
maintenance,
(b) at openings into smoke shafts described in Subsection 3.2.6. that are
less than 1070 mm (42 in) above the floor, and
(c) at each raised floor, mezzanine, balcony, gallery and at any other
locations where the difference in floor elevations is more than 600 mm
(23.6 in).
Section 3.3.4 Residential Occupancy
3.3.4.7 Guards for Residential Occupancies. Guards around balconies in
balconies of residential occupancy shall be designed so that no member,
attachment or opening located between 100 mm (4 in) and 900 mm (35.4 in)
above the balcony will facilitate climbing.
Part 9
Housing and Small Buildings
Section 9.8
Stairs, Ramps, Handrails and Guards
9.8.8.5 Design to Prevent Climbing. Guards around exterior balconies shall
be designed so that no member, attachment or opening between 100 mm
(4 in) and 900 mm (35.4 in) above the balcony floor will facilitate climbing.
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F. NATIONAL BUILDING CODE OF CANADA (NRC-NBC 2005)
Part 3
Fire Protection, Occupant Safety and Accessibility
Section 3.3. Safety within Floor Areas
Section 3.3.1. All Floor Areas
3.3.1.18. Guards
1)
Except as provided in Sentence (4) and Article 3.3.2.9., a guard not less
than 1070 mm (42 in) high shall be provided
a) around any roof to which access is provided for purposes other than
maintenance,
b) at openings into smoke shafts referred to in Subsection 3.2.6. that are
less than 1070 mm (42 in) above the floor, and
c) at each raised floor, mezzanine, balcony, gallery, interior or exterior
vehicular ramp, and at other locations where the difference in level is more
than 600 mm (23.6 in).
3) Unless it can be shown that the location and size of openings do not
present a hazard, a guard shall be designed so that no member,
attachment or opening located between 140 mm (5.5 in) and 900 mm
(35.4 in) above the level protected by the guard will facilitate climbing.
Section 3.3.4 Residential Occupancy
3.3.4.7 Stairs, Handrails and Guards for Dwelling Units
1)
Stairs, handrails and guards within a dwelling unit shall conform to
Section 9.8
Section 3.4
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Section 3.4.6. Types of Exit Facilities
3.4.6.5. Guards
1) Every exit shall have a wall or a well-secured guard on each side.
7) Unless it can be shown that the location and size of openings do not
present a hazard, a guard shall be designed so that no member,
attachment or opening located between 140 mm (5.5 in) and 900 mm
(35.4 in) above the level being protected by the guard will facilitate
climbing.
Section 3.4.7. Fire Escapes
3.4.7.6 Guards and Railings
1) The open sides of every platform, balcony and stairway forming part of a
fire escape shall be protected by guards not less than 920 mm (36 in)
high measured vertically above the nosing of any tread or platform.
5) Unless it can be shown that the location and size of an opening do
not present a hazard, a guard for a fire escape shall be designed so that
no member, attachment or opening located between 140 mm (5.5 in) and
900 mm (35.4 in) above a platform or the nosing of any tread will
facilitate climbing.
Part 9
Housing and Small Buildings
Section 9.8
Stairs, Ramps, Handrails and Guards
Section 9.8.8 Guards
9.8.8.1 Required Guards
1)
Except as provided in Sentences (2) and (3), every surface to which
access is provided for other than maintenance purposes, including but not limited to
flights of steps and ramps, exterior landings, porches, balconies, mezzanines,
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galleries and raised walkways, shall be protected by a guard on each side that is
not protected by a wall for the length where
a) there is a difference in elevation of more than 600 mm (23.6 in) between
the walking surface and the adjacent surface, or
b) the adjacent surface within 1.2 m (47.2 in) of the walking surface has a
slope of more than 1 in 2.
9.8.8.6 Design to Prevent Climbing.
1)
Guards required by Article 9.8.8.1., except those in industrial
occupancies and where it can be shown that the location and size of
openings do not present a hazard , shall be designed so that no
member, attachment or opening will facilitate climbing.
2)
Guards shall be deemed to comply with Sentence (1) where any
elements protruding from the vertical and located within the area
between 140 mm (5.5 in) and 900 mm (35.4 in) above the floor or
walking surface protected by the guard
a)
are located more than 450 mm (18 in) horizontally and vertically from
each other,
b) provide not more than 15 mm (0.6 in) horizontal offset,
c)
do not provide a toe-space more than 45 mm (1.8 in) horizontally
and 20 mm (0.8 in) vertically, or
d) present more than a 1-in-2 slope on the offset.
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G.
BUILDING CODE OF AUSTRALIA (BCA 2005)
Applicable Buildings
Class 1: One or more buildings which in association constitute (a) Class 1a - a single dwelling being (i) a detached house; or
(ii) one of a group of two or more attached dwellings, each being a building,
separated by a fire-resisting wall, including a row house, terrace house,
town house or villa unit; or
(b) Class 1b - a boarding house, guest house, hostel or the like (i) with a total area of all floors not exceeding 300m2 measured over the
enclosing walls of the Class 1b; and
(ii) in which not more than 12 persons would ordinarily be resident, which is
not located above or below another dwelling or another Class of building
other than a private garage.
Section 3.9.2.3 Balustrades or Other Barrier Construction
(a) Required when a walking surface is 1 m (39.4 in) or greater above an
adjacent surface.
(b) For floors more than 4 m(13 ft) above the surface beneath, any
horizontal elements within the balustrade or other barrier between 150 mm
(6 in) and 760 mm (30 in) above the floor must not facilitate climbing.
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H.
New Zealand Building Code 2007
Clause F4 Safety from Falling
OBJECTIVE
F4.1 The objective of this provision is to safeguard people from injury caused by
falling.
FUNCTIONAL REQUIREMENT
F4.2 Buildings shall be constructed to reduce the likelihood of accidental fall.
PERFORMANCE
F4.3.1 Where people could fall 39.37-inches or more from an opening in the
external envelope or floor of a building, or from a sudden change of level within
or associated with a building, a barrier shall be provided.
Acceptable Solution F4/AS1
1.0 Barriers in Buildings
1.1 Barrier heights
1.1.1 Minimum barrier heights are 35.4-inches for landings and 39.37-inches for
balconies and decks, and edges of internal floors or mezzanine floors.
1.2 Barrier construction
1.2.1 In housing and other areas likely to be frequented by children under 6 years
of age:
a) Figures 1-4 (1 and 2 are noted below) show acceptable barrier constructions
b) Openings anywhere over the full height of the barrier shall be such a size that
a 3.94-inches diameter sphere cannot pass through them…
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Illustration Courtesy of the Department of Building and Housing
www.dbh.govt.nz
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Illustration Courtesy of the Department of Building and Housing
www.dbh.govt.nz
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Appendix B
National Electronic Injury Surveillance System (NEISS)
Data Set 2002 through 2005
Consumer Product Safety Commission
Introduction
The purpose of this section is to discuss the nature of information contained in the
National Electronic Injury Surveillance System (NEISS) as it relates to injuries to children
between the ages of 18 months and 4 years (inclusive) that result from climbing on
guards. A guard, as defined on page 14 of the 2006 edition of the International
Residential Code, is “a building component or a system of building components located
at or near the open sides of elevated walking surfaces that minimizes the possibility of a
fall from the walking surfaces to a lower level.” An examination of NEISS data from
recent years for records in the system that relate to guard-involved injuries was
conducted.
The Consumer Product Safety Commission (CPSC) maintains the NEISS which is a
database system of consumer product-related injuries. The NEISS data consists of
information provided by a sample of hospital emergency departments in the United
States and its territories. Collection of the data begins when a patient gives the details of
an injury to a nurse, doctor or clerk in the emergency room of one of the NEISS
participating hospitals. Hospital personnel enter the information into the patient’s medical
records. At the conclusion of each day, a designated NEISS coordinator gathers relevant
cases from the day’s records. The coordinator abstracts information for the required
NEISS fields and transcribes all needed information to coding sheets and enters the
coded data into a NEISS personal computer installed at the hospital. The data entry
software includes error checking routines to ensure the validity of the entries. CPSC
collects the information via telephone lines nightly.
The resulting information contained in the data system is, at times, cited in literature
concerning injuries related to specific consumer products including such building
components as guards. Web access to the system allows information to be downloaded
and analyzed by interested parties. This feature made it possible to download NEISS
records for the years 2002 through 2005.
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Data Examination
NEISS data records include two product code fields that together identify up to two
consumer products that were involved in an injury. Each field can contain a numeric
code that is associated with a specific consumer product. Supporting documentation
published by the CPSC provides a listing of the codes and the meaning of each.
A search of the documentation revealed no product code corresponding to the word
“guards” (other than Guardrails which are not reported). In the absence of such a code,
product codes for “Handrails, railings or banisters” (1829), and for “Porches, balconies,
open side floors and floor openings” (1817) were selected for use as filters in a search of
NEISS records for the years 2002 through 2005 for “guard” associated injuries related to
children between the ages of 18 months and 4 years.
The table below reflects the resulting year-by-year and total record counts for the data
used. As can be seen, the NEISS database contains a total of about 1.4 million injury
records for the four-year period. Of these records, 2,222 contained either the code 1817
or 1829 and involved a patient between the ages of 18 months and 4 years. Table B 1
below presents a breakdown of the records by year.
Table B 1
Tabulations on NEISS Records 2002 - 2005
Year
Total number or
records In NEISS
database
Age 18 months to 4
years
Age 18 months to 4
years and Product
Code = 1817 4 or
1829 5
2002
359,980
41,507
553
2003
347,389
39,793
562
2004
353,394
41,460
609
2005
360,374
41,168
498
Total
1,421,137
163,928
2,222
The NEISS records originate in hospitals that are selected to serve as a probability
sample of hospitals in the United States. Since the resulting data represents a sample of
the emergency room visits, each of the records in the data system contains a weight that
allows extension of the reported incidents to estimates of the number of incidents
occurring nationally. Summing of the weights for each record in a set satisfying a given
criterion produces an estimate of the number of such incidents that result in visits to
emergency departments at the national level. Table B 2 below presents the number of
4
5
Product Code 1817 (Porches, Balconies, Open-Side Floors Or Floor Openings)
Product Code 1829 (Handrails, Railings Or Banisters)
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records over the four-year period for the categories presented above and the
corresponding national estimates based on these weights.
Table B 2
Weighted National Estimates Based on Tabulations of NEISS Records 2002 - 2005
Records in NEISS Database
National Estimate
Total records In
NEISS database
Age 18 months to
4 years
1,421,137
51,217,603
163,928
4,469,111
Age 18 months to
4 years and
Product Code =
1817 or 1829
2,222
53,818
As a way of comparison, a query of data records from the 2002 - 2005 NEISS data
system for injuries to patients between 18 months and 4 years produced the following
results for Balconies, Stairs, and Windows.
Table B 3
Number of Records Found in NEISS Data Years 2002 through 2005
for Incidents Involving Patients 18 Months through 4 Years of Age
Product Code Categories
Porches, Balconies, Open Side Floors and Floor Openings
Stairs 7
Windows 8
6
Number
of
Records
1,534
10,306
2,209
National
Weighted
Estimate
38,827
250,274
54,682
Examination of NEISS Records for Climbing of Guards
Since the focus of this paper is injuries resulting from climbing guards, a preliminary
search of the narrative fields of the 2,222 records for some form of the word “climb” or a
synonym was formulated. A search of Merriam-Webster’s Online Thesaurus yields the
following synonyms for the word “climb”—clamber, scramble. It also identifies shin,
shinny, inch, mount, scale, surmount, claw, and struggle as related words and refers the
reader to the word “ascend.” The synonyms for ascend are listed as arise, climb, lift,
mount, rise, soar, up, uprise, upsweep, upturn. Related words are boost, elevate, raise,
uplift, upraise, take off, zoom, crest, scale, surmount and top. From this list, the following
words were selected to be used for keyword searches of the narrative fields: climb,
6
Product Code 1817 (Porches, balconies, open-side floors or floor openings)
Product Codes 1840 (Pull-down or folding stairs) and 1842 (Stair or steps (excluding pull-down or folding
stairs))
8
Product Codes 1826 (Storm windows), 1828 (Window screens), 1836 (Jalousie glass windows), 1870
(Windowsills or frames), 1873 (Windows or window glass, not specified), 1875 (Other windows or window
glass), 1888 (Window or door security barriers) and 1894 (Windows and window glass, other than storm
windows)
7
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ascend, clamber, mount, scale, scramble or shin(ny). The resulting search yielded 27
records.
Examination of the narrative fields of the 27 records revealed that eight of these records
were related to climbing on items other than rails, railings or banisters: climbing steps or
stairs (3); climbing on chairs (3); and climbing on other objects (playground equipment
located on porch and a gate) (2). Another three records indicated patient climbing
through the railing or banister, and four other records reflected some degree of
ambiguity in the circumstance or some action other than climbing on a rail, railing or
banister (climbing on Mom, climbing on rock box or rail, climbing on a terrace and fell 1
foot and climbing over a second floor balcony).
The narrative descriptions of the remaining 12 records indicated or were suggestive of
climbing on either a banister, railing, or over a rail. However, one of these records
indicated that the patient was climbing on a railing that separates checkout stands.
Another record referred to a railing associated with steps outside a department store. Of
the remaining ten records, none included the word guard.
Second Examination of NEISS Records
An additional examination identified records that had the same product codes and age
constraints that also contain one of the keywords: fall, fell, jump, leap, slip, standing on,
stood on, straddle and that refer to terms that could be used to represent a guard.
As indicated earlier, the NEISS Product Category 1829 is titled “Handrails, railings, or
banisters.” Since no category corresponding to guards other than guardrails exists, this
product code was deemed the category for classifying guard-related injuries. A handrail,
as defined by the Merriam-Webster Online Dictionary, is “a narrow rail for grasping with
the hand as a support.” This definition would seem to rule out incidents involving hand
rails as guard-related. Similarly, the same source defines a banister as “a handrail with
its supporting posts.” Since this term, along with handrail, is likely associated with stairs
or ramps and not guards, both terms were not used in the search criteria. A railing is
defined as “a barrier consisting of a rail and supports.” The definition given for the term
rail includes: “a bar extending from one post or support to another and serving as a
guard or barrier.” While the definition of the term railing appears to be closest to the term
guard, the definition of rail as a member of a railing assembly indicates that records
using the term rail should not be ruled out. A balustrade is defined as “a row of balusters
topped by a rail.” The definition of a baluster includes—“an upright often vase-shaped
support for a rail.” Balustrade and baluster were also retained for use in the query.
Based on the above information, the following terms were added to the search criteria:
rail; baluster; balustrade; or guard. The resulting overall criteria for identifying records
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potentially related to the guard-related injuries was formulated to consider records with a
product code of 1817 or 1829 for patients between the ages of 18 months and 4 years
where the narrative includes one of the following terms: fell; jump; leap; slip; standing on;
stood on; or straddle, and one of the following terms: baluster, balustrade, rail or railing.
The following table presents the results of the search broken down into categories based
on the occurrence of either railing or rail and other words or phrases mentioned in the
narrative that accompanies each record. This search resulted in the identification of 312
records. Not all of these records reflect falls, jumps or slips from or over guards or
standing on or straddling them. Records that satisfied the criteria but were related to
other types of incidents were also identified. The search identified 75 records that
appear to be related to incidents involving falls, jumps, or slips from or over guards or
standing on or straddling them.
Table B 4
Railing or Rail Related Records
Classification
Fell Against or Struck Rail or Railing
Hanging or Swinging On or Swinging Off
Miscellaneous/Other
Sliding On or Down
Steps or Stairs Environs
Uncertain Circumstances or Unclear Descriptions
Jumps, Falls, Slips From Rail or Railing
Total
Railing
86
8
24
2
60
12
60
236
Rail
14
2
10
1
17
1
15
60
Combined
100
10
34
3
77
13
75
312
While every effort was made to develop a meaningful system for categorizing the
incidents, the classification of the identified injuries into the above categories was
necessarily subjective at times. Alternative classifications of some records were
possible. The purpose of this effort was to identify records that seem to represent falls
from guards. Given this, record counts for other categories should not be taken as the
basis of comprehensive estimates for those categories. It also should be noted that the
incidents reflected in the table above included incidents that occurred at home and
elsewhere. No attempt was made at that stage to limit the findings to incidents occurring
at home.
Records Reflecting Jumps, Falls, or Slips From a Rail or Railing
In summarizing the 75 rail- and railing-related records, it appears that 61 occurred in the
home, at daycare, or in an unknown place. The other 14 seemed to have occurred in
settings that might not be relevant to the subject of guards.
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The locations of these 14 incidents include a zoo, stores, the fairgrounds, a park, places
for recreation or sports (ballgame), a restaurant, the motor vehicle department, a school,
and possibly other public places. The records indicate the following circumstances: fell
backward off railing at zoo; climbing on the railing that separates checkout stands and
fell; fell off of a railing; fell from a railing 7 to 8 feet; fell from railing at fairgrounds; fell
over railing while feeding the ducks at the park; flipped over railing and fell 2 feet at
store; sitting on a railing and fell backwards 3 to 4 feet; standing on railing and fell into
seat in front of him; fell from a rail while at a ballgame; sitting on a rail while at restaurant
and fell; fell forward off a rail and landed on the linoleum floor at the MVD; and fell off rail
at school. Since these incidents may not be the type that would involve a guard intended
to stop falls off a balcony or from a similar location, these records were dropped from
further discussion.
Of the 61 remaining records of incidents occurring at home, daycare or in an unknown
place, the narratives of 19 provide little information other than the occurrence of a fall,
slip or jump from a rail or railing. One indicates the patient was walking on a rail. Another
indicates climbing on a rail. The product code fields of these 19 records indicate the
involvement of the product category “Handrails, railings or banisters” with no entry in the
second product code field.
The narrative entries for another 20 of the 61 records indicate a fall off, over, or on a rail
or a jump from a rail associated with a deck, a patio, a porch or a balcony.
The narrative information in the other 22 records contains varying amounts of
information concerning the circumstance of the incident. Six indicate only that the patient
fell from or off a rail or railing and struck either concrete or cement. One indicates the
patient was climbing on a rail and fell against a wall. Six indicate falls of 4 – 7 feet, two
records indicate a fall from a second story, one indicates a fall over a 3-foot railing, one
patient flipped backwards from a 3-foot railing, two others indicate that the patient struck
the ground, one indicates a jump from a railing onto the floor, one patient was playing on
an iron railing, and one patient fell over a railing at daycare.
Weighting Records to National Estimates
As stated earlier, the NEISS records originate in the emergency department of hospitals
that are selected to serve as a probability sample of hospitals in the United States. Each
record in the data system contains a weight that allows extension of the reported
incidents to estimates of the number of incidents occurring nationally that result in visits
to emergency departments. Summing of the weights for each record in a set satisfying a
given criterion produces an estimate of the number of such incidents occurring at the
national level. A table presenting record counts and the corresponding weighted
estimates and their average annual values is presented below. The annual estimates are
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based on a simple average over the four-year period. This approach was adopted since
no consistent trend was noted for the four-year period.
Table B 5
Breakdown of 61 Records, Corresponding Estimates and Annual Averages
Category
Little to no detail
Additional level of detail
Involves balcony, deck or porch
Total
Record
Count
19
22
20
61
Weighted
Estimate
252
614
548
1,415
Weighted
Annual
Estimate
63
154
137
354
Based on the weights in the identified records, the estimate of incidents that occurred
between 2002 and 2005 nationally that correspond to the category involving balconies,
decks, patios, porches or balconies is 548. The number corresponding to the records
with narrative entries containing little amplifying data is 252. The weights for records with
narratives that contain more information sum to 614. Their combined weights come to
1,415. These estimates represent estimates for a four-year period. The annual averages
based on these estimates are 137, 63, 154, and 354, respectively.
A weighted estimate of 53,818 is indicated by the 2,222 records of incidents among
patients between the ages of 18 months and 4 years involving either the product code
1817 or 1829. The weighted estimate based on the 163,928 records for children
between 18 months and 4 years is 4,469,111 or an average over the four years of
1,117,278. The 137 annual average incidents corresponding to the records mentioning
balconies, decks, or porches represent approximately 0.01 percent of the 1,117,278
child-involved incidents. The 354 weighted-annual estimated incidents, based on the 61
records identified above, represents approximately 0.032 percent of the estimated
1,117,278 annual child-involved incidents.
Conclusions
The above identification and classification of injuries by category is not intended to be an
exhaustive analysis of the details of the NEISS data for injuries resulting from children
between the ages of 18 months and 4 years of age climbing guards. The goal of the
examination was to provide a basis for the assessment of the usability of the NEISS data
to identify such injuries. Because the NEISS data system has no product code
corresponding precisely to guards on balconies and other elevated walking surfaces, the
study adopted an approach consisting of the use of a combination of product codes to
serve as a proxy for the concept of the guards in searches of the NEISS data system.
Two searches of the narrative entries of the resulting records were conducted. The first
made use of synonyms for the term “climb.” The second made use of a selection of
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words with definitions that seem to correspond to the meaning of the term “guard.” The
use of these definitions was, of necessity, literal and may have excluded (or alternatively
included) records with words that were used inconsistently with the definitions presented
above. No adjustment was made for such cases. This latter search also included terms
for falling, jumping or slipping to denote the nature of the incident causing action.
Constructing the methodology and examination of the results revealed some areas
where modification of the NEISS system could provide better definition for insights into
guard-climbing injuries among children. A brief discussion of these insights and
suggestions follows.
The first issue encountered during the analysis is that no product code corresponding
precisely to a “guard” exists. The closest existing product code category, (1829)
“Handrails, railings or banisters,” is a more broad-spectrum term that allows the inclusion
of assemblies on stairs, ramps and places that might not be on elevated walking
surfaces. While the nature of the NEISS system may make it necessary to use broad
terms in order to limit the number of product codes in the system, this may make more
narrowly focused studies problematic. The addition of a specific guard category might
help clarify the circumstances surrounding any guard climbing incident.
An initial search indicated that 2,222 records reflect injuries to children between the ages
of 18 months and 4 years and contain either the product codes for the category
“Handrails, railings or banisters” or the category “Porches, balconies, open side floors
and floor openings.” A search of these records for synonyms for climbing was used as a
proxy for situations involving a guard-related injury. It yielded 27 records. Some records
contained narrative descriptions that indicated the climbing actually involved some other
object, such as a chair, a piece of playground equipment or steps or stairs The
description lead to the conclusion that these incidents are unrelated to injuries related to
climbing of guards. Other records indicated climbing on a banister, rail or railing.
An additional search of the 2,222 records for narrative entries that contain the words fall
or fell, jump, leap, standing on, straddle, and mention rail, railing, balustrade or baluster
yielded 312 records. An examination of these records identified 75 that appear to
indicate the patient jumped, leaped, fell or slipped from a rail or railing. Unfortunately,
most of these records did not indicate how the patient got onto the rail assembly.
References to climbing or one of its synonyms were relatively sparse. A subsequent
analysis of the 75 records indicated that 14 occurred at locations that were not identified
as a home or daycare facility and may not involve guards on balconies or similar
locations. The amount of details in the narrative descriptions of the remaining 61 records
varied greatly. Additionally, many of the records included entries for only one product
code – “Handrails, railings or banisters.” When narratives of such records do not go
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beyond stating that the patient fell off a railing and indicating that the victim sustained
some type of injury, it is difficult to identify the nature or setting of the fall.
Based on weighting factors contained in the NEISS data system, the 20 records
reflecting a fall off, over or from a rail or railing correspond to an estimated 548 similar
incidents in the underlying population (27.4 multiplier). The 61 records associated with
incidents identified as occurring in the home, daycare or an unknown place likewise
correspond to 1,415 estimated incidents (23.2 multiplier). These figures represent about
0.01 percent and 0.032 percent, respectively, of the incidents estimated to have
occurred among patients between the ages of 18 months and 4 years in the years 2002
through 2005.
Some degree of uncertainty is associated with these weighted estimates. The first type
of uncertainty stems from the use of statistical sampling and is unavoidable with any
approach short of a census of the entire population of hospitals. CPSC provides a
statistical method to establish upper and lower bounds on weighted estimates of the
NEISS data. The magnitude of uncertainty can be seen in the confidence interval of the
estimates. Using the “fractional n approach” to compute the variance produces a 95
percent confidence interval of ± 301 with a lower bound of 247 and upper bound of 849
incidences for the 548 estimated incidences. The interpretation of the interval is that this
interval would include the average result of all possible samples 95 percent of the time.
Converting these figure to an annual average basis produced an estimate of 137 with
lower and upper bounds of 62 and 212, respectively.
The other type of uncertainty is related to the lack, at times, of sufficient descriptive
details in the records and the subsequent classification of incidents in this study based
on that information.
The ability to isolate specific details is a significant factor in understanding the
mechanism of the type of incident being reported. One possible enhancement to the
NEISS system would entail the addition of some type of code that would identify the
precipitating action of an injury-producing incident, such as “climbing.” Another
improvement would entail the use of more precise wording. The response to an inquiry
to the CPSC indicated that no further definition of the terms included in the product code
listing of the NEISS Product Code Comparability Table or the NEISS Coding Manual
exists. Product Code 1829 contains no definition other than that provided in the title Handrails, railings or banisters. In addition, the terms rail or railing can be vague. The
selection of the 1829 code and the use of the term rail or railing without further details
can fail to communicate the exact circumstance of the incident. The resulting vagueness
encountered by readers of the data might contribute to interpretations that result in
controversy. One solution would be to create an additional reference document with
expanded definitions for terms contained in or related to the product codes contained in
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the other documents. This reference could be a helpful resource for both data entry and
subsequent analysis. Additionally, encouraging the inclusion of more details in narrative
descriptions, when possible, could further enhance the usability of the data.
NEISS documentation indicates that follow-up investigations are often required to gather
additional information because the NEISS surveillance data reflects only product
involvement not causation. Follow-up investigations can make use of telephone
interviews and on-site investigations. This type of follow-up investigation could well shed
light on the full circumstances surrounding the reported incidents, reduce much of the
associated uncertainty and perhaps produce a clearer picture of the number of incidents
resulting from climbing on guards.
The comments in this section are not meant as a criticism of NEISS. Collecting and
maintaining the amount of data in the system is a substantial undertaking. The
comments are meant as suggestions for perhaps reducing some ambiguity in the data
and improving its usability from the perspective of this study.
NEISS Case Numbers
The following tables contain the case numbers corresponding to the data records
identified during the course of the NEISS data examination. The first table contains a
breakdown of the NEISS case numbers by the categories that were contained in the
tabulation of 312 rail or railing related records presented in the text of the report.
Immediately following is a listing by category of the 61 records related to incidents
occurring in a home, daycare facility or an unknown location involving a jump, leap, fall,
slip from a rail or railing.
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Table B 6
Case Numbers of 312 Rail or Railing Related incident Records in NEISS Tabulation
Stairs and
steps
Swinging
or hanging
on
Sliding on
or down
Unknown
or unclear
Jumped or
fell into
Misc./
Other
Jumps
20321953
20442816
40445098
20528174
20116393
20336853
20150907
20339843
20903544
40503776
21002460
20136095
21056551
20418787
20405815
30757220
50723382
30225318
20216789
21115944
20433374
20407320
31122317
30607831
20421746
30130566
20434923
20410901
40203383
31051158
20432652
30142326
20456411
20522902
40548817
40413016
20561822
30201138
20512248
20600425
40743637
40417772
20601338
30209110
20533101
20624232
40847984
40626537
20624080
30243154
20603128
20628721
40916498
41222144
20639200
30302327
20644268
20655141
50823853
50514692
20651847
30321020
20655117
20712583
50845394
20700012
30350637
20709149
20722416
51015461
20730185
30410727
20721324
20829164
51135208
20740419
30413643
20745250
20934103
20849692
30555414
20747826
20936404
20903128
30728339
20824307
21035208
20910091
30732196
20947550
21035301
20915196
30904572
21035185
21112358
20952769
31060980
21244651
21213203
21016545
31105835
30149086
21220354
21221621
31114644
30348875
30111361
30112521
40141214
30401885
30425333
30151841
40435014
30408454
30431984
30330496
40507264
30434904
30555450
30403295
40722612
30437507
30709926
30517768
40845978
30448799
30848751
30534271
40961785
30503924
30850438
30552166
41231148
30537449
30923781
30601099
50123891
30550764
31034567
30656005
50546285
30647328
31039184
30701557
50630926
30758889
40140115
30719234
50736325
30834250
40232092
30827320
50817176
30837045
40242544
30833165
50836513
30940596
40306041
30917141
50907582
30949442
40345428
31010131
30954444
40633645
31011767
30956517
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Stairs and
steps
Swinging
or hanging
on
Sliding on
or down
Unknown
or unclear
Jumped or
fell into
Misc./
Other
Jumps
40644658
31032760
31014124
40649112
31043862
31039255
40715833
31047090
31131155
40731850
31057458
31211476
40743676
31059624
40330781
40807172
31128719
40350322
40807428
31130166
40354381
40838033
31227701
40401215
40905173
31232962
40403961
40930950
40208963
40535648
40935361
40308033
40550500
41038517
40335550
40601219
41039317
40411701
40652824
41246987
40431403
40924391
50112935
40438363
41002222
50136749
40540660
41004724
50153990
40604544
41115146
50226530
40613161
41154384
50228931
40619636
50106287
50311382
40700256
50116891
50322920
40702049
50242706
50415024
40723890
50342433
50425012
40747998
50401414
50535310
40754774
50549537
50537954
40809107
50553652
50615936
40835497
50608194
50714012
40946984
50615241
50758974
40947699
50640385
50800130
40964682
50640770
50806971
41013370
50663602
50818853
41108887
50723823
50908846
41157993
50753170
50917578
41158417
50839566
50937900
41204126
50924471
50947937
41210066
51012559
51007952
41228745
51123191
51037543
41229263
51128516
51142301
41235896
51129921
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Stairs and
steps
Swinging
or hanging
on
Sliding on
or down
Unknown
or unclear
Jumped or
fell into
51201404
50100645
51250155
50136768
60106824
50242507
Misc./
Other
Jumps
51132281
50316719
50339316
50350503
50405838
50416886
50452788
50508394
50522045
50531410
50550675
50613398
50654190
50717683
50742955
50754354
50838603
50903071
50913341
50944915
51008704
51044066
51054310
51141728
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Table B 7
Case Number of 61 Railing or Rail Related Records Involving
a Fall, Jump, Slip from a Rail, or Railing
Deck, Patio, Porch or
Balcony Mentioned
Little Detail Presented in
Narrative
More Detail Presented in
Narrative
20433374
20456411
20644268
20434923
20533101
21035185
20512248
20603128
30434904
20655117
20947550
30437507
20745250
21244651
30837045
20747826
30149086
30949442
20824307
30401885
30954444
30348875
30408454
31014124
30550764
30956517
31211476
30758889
31131155
40350322
31039255
40403961
40354381
40401215
40535648
40601219
40550500
41002222
40652824
40924391
41004724
50106287
50608194
41115146
50401414
50640770
41154384
50549537
50723823
50342433
50553652
50924471
50640385
50663602
51123191
50753170
50839566
51132281
51012559
51128516
51129921
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Appendix C
Peer Review
Peer Review Summary
In October 2007 the National Ornamental & Miscellaneous Metals Association released
Review Of Fall Safety Of Children Between The Ages 18 Months And 4 Years In Relation To Guards
And Climbing In The Built Environment. This appendix provides a formal peer review of this
document, which was conducted in April of 2008. The appendix is organized into three
sections. First, this section presents a brief summary of the peer review process. Following
this section, the text of the three peer reviews is provided in their entirety. Finally, the
Curriculum Vitae of each reviewer is presented.
The peer review was envisioned as a means of providing the reader with the perspective of
experts in disciplines relevant to the subject matter of this report. The project team identified
potential candidates with backgrounds relevant to the subject of this study. The potential
areas of expertise included child development, biomechanics, epidemiology, and statistics.
Ultimately three candidates with suitable backgrounds were identified and their participation
solicited. They are:
•
Arthur K. McDonald - Mr. McDonald is a former Director of the Division of Hazard
and Injury Data Systems, US Consumer Product Safety Commission (CPSC). He is
currently a consultant to the National Center for Statistics and Analysis, National
Highway Traffic Safety Administration
•
Christine A. Readdick - Dr. Readdick is an Associate Professor of Child Development at
Florida State University.
•
Kimberly E. Stone - Dr. Stone completed an academic research fellowship and Masters
in Public Health at Johns Hopkins University in 2006. She is currently residing in
England.
Mr. McDonald was selected for his intimate knowledge of the NEISS data system; thus the
focus of Mr. McDonalds’ review is the material in the report related to the examination of
NEISS data described in Appendix B and summarized elsewhere in the report and abstract.
Both Dr. Readdick and Dr. Stone have backgrounds in relevant childhood-related research.
Dr. Readdick’s works include Achieving Great Heights: The climbing child, cited in this report. Dr.
Stone’s published research includes Childhood injuries and deaths due to falls from windows. The
focus of the reviews conducted by Dr. Readdick and Dr. Stone includes other sections of the
report dealing with Peer-Reviewed Studies and Background Information.
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Arthur K McDonald
16512 Montecrest Lane
Darnestown, MD 20878
April 17, 2008
Thomas Kenney
Vice President – Engineering and Research
NAHB
400 Prince Georges Boulevard
Upper Marlbore, MD 20774
Dear Mr. Kenney:
This letter provides my review of the document, “Review of Fall Safety of
Children Between the Ages of 18 Months and 4 Years in Relation to Guards
and Climbing in the Built Environment” December 2007 Edition. This
review will focus on the statistical analysis presented in Appendix B and the
use of this analysis in the main report.
The analysis presented in Appendix B uses injury data for 2002-2005 from
the National Electronic Injury Surveillance System (NEISS) collected and
maintained by the US Consumer Product Safety Commission (CPSC). The
analysis generally uses these data in an appropriate manner to develop
estimates of the annual number of injuries associated with children falling
from railings and guards. This review will contain three major sections.
The first section will provide a detailed critique of the procedures used in
Appendix B. The second section will discuss the use of the statistical data
from Appendix B in the body of the report. The final section will provide the
results of my analysis of the 2006 NEISS injury data that has recently been
published. This analysis uses similar techniques to those used in Appendix
B but enlarges the scope to ensure that relevant cases are identified.
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Section 1
This section will provide a detailed review of each part of Appendix B. The
parts of this section will have the same title as the corresponding part of the
report:
Introduction (Page B-1)
This part provides a useful and appropriate definition of the purpose of the
report and a general description of the NEISS data system used in the report.
Some readers might not realize that the analysis in Appendix B reflects the
data in the basic NEISS sample that includes only consumer product related
injuries and that these data represent a different data set than the “All Injury
NEISS” data set also collected by CPSC but disseminated by researchers at
the US Centers for Disease Control. Injuries associated with falls from
guards would be included in the basic NEISS and the most of the analysis is
not affected by the consumer product limitation. . However, many injuries
to children including motor vehicle injuries, intentional injuries and foodrelated injuries are not included in the basic NEISS. These injuries are
included in the “All Injury NEISS” also operated by the CPSC with financial
support from government agencies with responsibility for the other product
areas. One consequence of this is that the percentages of all injuries
published in Appendix B and in the document reflect the percentage of all
consumer product related injuries not the percentage of all injuries.
Data Examination (Pages B-2 to B-3)
The term guardrail mentioned in the NEISS coding manual as not reportable
refers to a highway guardrail that is not considered a consumer product and
injuries associated with guardrails are not generally reportable in the basic
NEISS for that reason. Injuries associated with other products under the
jurisdiction of other Federal agencies such as firearms, food and automobiles
are also not reportable in the basic NEISS. However, injuries associated
with guards used in building structures should be reported using the railing
code or possibly using other product codes that identify products such as
floors, balconies or stairs that were also involved in the injury incident.
The choice of the two codes (1829 railings and 1817 porches) in the search
for cases described in Appendix B is a reasonable choice, although I see no
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reason at this point to limit the search by product code. This search
identified 2,222 cases in the four year period 2002-2005 under these two
product codes.
The remainder of the section provides good background information with
interesting and accurate statistics on the sample counts and estimates for the
number of injuries treated in hospital emergency departments in several
different product areas.
Examination of NEISS Records for Climbing of Guards (Pages B-3 to B-4)
The challenge for an analyst using the NEISS to develop an estimate of the
number of injuries associated with any hazard is to devise a strategy to
identify the sample cases that fit the hazard pattern. The usual approach is to
use the coded variables and character string searches of the narratives to
identify a relatively small set of cases and read each of these cases to
identify a final set of sample cases that appear to fit the hazard pattern. This
final set of cases is used to generate the national estimates. That is the
process followed in Appendix B. The most difficult part of the process is
identification of the keywords used to filter the cases. It is helpful to see the
attempts to use different verbs (climb, fall, etc.) and nouns (rail, guard,
baluster, etc.) in this process.
This part reflects the efforts to identify injuries associated with children
climbing on guards by using a character string search of the 2,222 railing
and porch cases for the word ‘climb’ and synonyms. Only 27 cases were
identified and most of these cases were out of scope because the scenarios
did not involve climbing on the type of guards of interest in this study. It
appears that this attempt to identify cases was not successful because the
short narratives describing the incidents usually used the word ‘fall’ to
describe the incident sequence and not the word ‘climb’ that might have
described the cause of the incident.
Second Examination of NEISS Records (Pages B-4 to B-5)
A second examination of the 2,222 records previously identified used two
search strategies. The first search of these records identified 312 records
with a keyword such as “rail”, “baluster”, or “balustrade”. The word
“banister” was not used despite its similarity to the words used because of its
likely use as a stair rail and not a guard. The choice of words to use in the
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search is complicated by the fact that the words in the NEISS narrative are
often the words used by the victim or family members to describe the
incident and may not fit the technical definition of the words. A second
search of these 312 records identified 75 of these 312 records that also had a
keyword such as ‘fell’ or ‘jump’. These 75 records formed the basis for the
subsequent analysis. This approach is sensible and appropriate although
each character string search has the potential to exclude relevant cases that
lack any of the specified keywords. Keyword searching is a powerful tool to
filter large numbers of cases to identify specific cases of interest. Keyword
searching may miss some cases if an incident is described with an
unanticipated combination of words or if the coder misspells a keyword.
Records Reflecting Jumps, Falls or Slips From a Rail or Railing (Pages B-5 to B-6)
This part reflects the results of the case-by-case review of the 75 records
identified in the last section. This review is a necessary and appropriate step
and identified 61 cases that occurred in homes, daycare or unknown
locations and are included in the final analysis of these data.
Weighting Records to National Estimates (pages B-6 to B-7)
The weights for the 61 cases identified for the four years of analysis were
added to produce an average annual national estimate of 354 injuries This
number appears to be a useful estimate and results from a reasonable
analysis of the data. The statement that this estimate of 354 injuries is 0.032
percent of the estimated annual total of 1,117,278 child ED treatments is true
but seems to provide information that is redundant and useful only to
demonstrate that the estimated number of injuries after falling from guards is
a small percentage of the total number of injuries in this age group. It
should also be noted that the percentage applies only to all child consumer
product related ED treatments and would be even lower if all child injury
ED treatments or all child injuries were included in the denominator..
Conclusions (Pages B-7 to B-10)
The first part of this section contains some appropriate caveats about the
analysis and the necessarily limited results attainable from character string
searches of short narrative summaries. The study did achieve its goal of
showing the feasibility of using the NEISS data to identify injuries to children
between the ages of 18 months and 4 years from climbing on guards.
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The author makes several recommendations that would enhance the utility of
the NEISS for conducting studies such as this in the future. These
recommendations involve such issues as the use of more specific product
codes including a code for the guards that are the subject of this study,
collection of more detail in the narrative section of the record and coding of
the precipitating action for the injury incidents. These recommendations are
sensible and appropriate from the analyst’s point of view. There is currently
an effort to code the precipitating action for a subset of the cases in the
system. However, the set of precipitating event codes does not include the
level of specificity necessary to support this study. Addition of new
precipitating event codes would not improve the data unless the hospital
records contain the detail necessary to support these codes. The CPSC must
work with the participating hospitals to improve the level of detail in the
basic emergency department records before significant progress could be
made to implement any of these recommendations. The effort to improve
the level of detail must coexist with efforts to streamline data collection in
the hospitals and must recognize that the hospitals’ basic mission to treat
injuries and save lives will always have priority over data collection.
This part includes a paragraph discussing the sample variation inherent in
any estimate produced from a probability sample such as the NEISS. The
sampling variance is an issue when considering the NEISS estimates but
measurements of the sample variance are unreliable when the estimates are
small. CPSC policy does not permit publication of variances when the
estimate is less than 1,200 and in this example the four-year estimate is 548.
Also it appears that the analyst converted the confidence interval for a fouryear estimate to a confidence interval for one year by dividing the upper and
lower limits by four, which would not be an appropriate technique to
estimate the single year confidence interval. Some mention of the variance
is appropriate but I would omit the calculation since it is not an important
part of the presentation.
The suggestion to conduct follow-up investigations to collect additional
details on specific cases is an excellent suggestion. These investigations can
be conducted by telephone and can provide useful additional details. Such
investigations have been conducted by the CPSC for special studies in many
different product areas and have provided the basis for many useful
analyses. Generally another Federal agency would have to contact CPSC
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and provide the funding if the project involved a product such as building
guards that was not in the CPSC operating plan.
NEISS Case Numbers (Pages B-10 to B-14)
This part provides the case information that allows the reader to reproduce
the author’s results. This is an important and valuable part of the report.
Section 2
This section will provide a review of the use of the findings from Appendix
B in the main body of the document.
The Abstract (page I) and the Executive Summary (Page IV) present the
injury data for climbing and falling from guards as 0.032 percent of all
injuries to children 18 months to 4 years of age resulting in emergency room
treatment. This statement is supported by the work in Appendix B and the
narrative on pages 6 and 7.
However, this percentage seems unnecessarily obscure and the reader would
be better informed by the equivalent national estimate of the number (354)
of children of this age treated annually for this type of falls. The reader also
should be reminded that injuries treated in hospital emergency rooms are
only part of the total injury experience. There are other injuries treated in
clinics, homes, doctor’s office and possibly some cases that result in death
with no treatment at all.
The percentage (0.032%) is the percent of product related injuries treated in
hospital emergency departments. The percentage would be even smaller if
the denominator included other injuries treated in hospital emergency
departments such as motor vehicle injuries, food injuries and intentional
injuries.
A summary of the results from Section B is presented on pages 6 and 7 of
the main document. This summary is generally an accurate representation of
the information in Appendix B.. There are several minor points that should
be clarified.
The major finding is the annual estimate of 354 injuries treated in hospital
emergency departments not the percent of 0.032 of “all” injuries that is
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repeated in this section. It is true that the estimated 354 injuries is a very
small percentage of the total number of emergency department treated
injuries for this age group.
The narrative fields in the NEISS data records are not the ‘hospital
administrators interpretation and annotation of the event’ and the narrative is
never left blank. The narrative fields are the most detailed verbatim
description of the injury incident entered on the emergency department
record by any of the ER staff including physicians, nurses or clerks. The
narrative field may be brief and vague, but it is part of every NEISS record
and the best description of the injury incident available from the hospital
record.
Section 3
This section provides my analysis of the recently available 2006 injury data
and shows that a slightly different analytical approach provides similar
results to the findings presented in Appendix B and used in the document.
The website https://xapps.cpsc.gov/NEISSQuery/home.do maintained by
the CPSC provides the raw data for NEISS which includes records of
emergency department treatments from a national probability sample of
hospital emergency room treated consumer product related injuries. The site
provides sample counts, estimates and raw data for use by analysts
addressing any consumer product safety issue.
The data used in the document under review were retrieved from this site
and covered the years 2002 through 2005. The CPSC web site now includes
the data for 2006 and my review looked only at the data for 2006. My
analysis took a slightly broader approach to the analysis, but found results
consistent with the results found in Appendix B and used in the document.
There were 363,616 product related injury reports for 2006 in the database.
These reports covered an estimated 13,200,000 product related injuries
treated in US hospital emergency departments in 2006. There were 41,689
product-related injury reports for children 18 months through 4 years of age.
These reports covered an estimated 1,150,622 product related injuries for
children in this age group for 2006.
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Each of the 41,689 data records contains certain coded data variables and a
short narrative description of how the injury occurred. The information in
these records is taken directly from the hospital emergency department
reports and these data records include only information collected during the
normal course of injury treatment in a hospital emergency department.
The main challenge for this analysis is to review these records and identify
the records associated with children injured after climbing and falling from
guard rails. Once the relevant cases are identified, a national estimate can be
generated by summing the weights for the cases identified. There are three
major steps in the process to identify cases of interest. The analysis in
Appendix B used all three methods. The first step was to limit the search of
the injuries to children and restricting the search to two product codes (1829
Handrails, railings, …and 1817 Porches, balconies, …). The second step
was to screen the cases identified with these codes to identify cases where
the victim had fallen and the product was identified as a railing or guard by
using a limited set of character strings to search for possible cases. The third
step was to read the cases identified in steps 1 and 2 and identify the cases of
interest.
My search of the 2006 cases limited the search to children but included all
cases without regard to product. The subsequent steps were used to identify
the cases of interest from all cases in the NEISS sample. Step 2 was
simplified by searching only for cases with keywords associated with guards
such as ‘guard’, ‘rail’, ‘banister’, ‘baluster’, etc.
This initial review
identified 329 cases for further analysis. After quickly eliminating obvious
false positive cases with keywords such as lifeguard and bedrail, there were
180 cases left to review to identify the cases of interest. After reading the
180 cases, 30 cases were identified where the victim appeared to have fallen
off some type of railing or banister. Twenty-eight of the 30 cases had been
coded as product 1829 or 1817. So the search strategy of including all
product codes only identified two additional cases and both of those cases
involved railings that could have been coded as 1829. The cases identified
from this review of the 2006 cases are listed below:
DAD TRIED TO GRAB CHILD WHEN SHE WAS FALLING OFF BANISTER / SHE TRIPPED OVER RUG
FELL FROM RAIL 1 FLOOR ONTO CARPETED FLOOR DX: CHI W/ VOMIT
FELL OFF PORCH RAILING SCRAPPING EYEBROW ON THE WOOD " LAC'
PT WAS CHASING GRANDMA AND LEANED OVER BALCONY RAILING AND FELL FROM BA L
PT WAS @ HOME CLIMBING ON RAILING OF THE PORCH FELL ONTO FACE. SWELLING TO LIP. D
PATIENT FELL FROM 2ND STORY BALCONY, OR OFF 2ND STORY BANISTER, LANDED ON CA
FELL FROM PORCH OF TRAILER HOME 3-4' & HIT HEAD ON BIKE D-CONTUSION D2 -CHI D3 DI
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2YOF FELL FROM DECK RAILING 5FT SUPERFICIAL LAC UPPER LIP CONTUSION LOW ER LIP
PATIENT FELL 8-9 FT WHILE LEANING OVER STAIR RAILING OUTSIDE APARTMENT, LANDED
NO APPARENT INJURIES-FELL 9 FEET OVER BANISTER TO FLOOR-@ HOME
JUMPED OFF RAILING. DX CHEEK ABRASION
LOWER ARM CONTUSED, FELL OFF RAILING
PT FELL OFF STAIR RAILING- NO LOC, BUT HAS ARM DEFORMITY DX: RT DISTAL RADIAL & U
FELL OFF RAILING & HIT HEAD, CHI
PT FELL 7 FT OVER BANISTER OF STAIRS. DX: TRAUMATIC BRAIN INJURY MILD.
PATIENT FELL OFF RAILING ON PORCH AT HOME, FELL ON CEMENT; CHEEK HEMATO MA, BRU
PT FELL CLIMBING ON A BANISTER AND FELL OFF . DX SHOULDER FX
4 YOM WAS CLIMBING A BANNISTER AND FELL CAUSING RIGHT ELBOW FRACTURE
PT JUMPED OVER DECK RAILING AND HIT KNEE ON METAL PIECE OF A POST. DX: 4.0 CM. LAC
FELL OFF RAILING AND HIT HEAD ON CONCRETE. DX HEAD INJURY - CONCUSSION
PT FELL OVER 2ND FLOOR RAILING AND LANDED ON WOOD FLOOR. DX: SKULL FX.
SWINGING ON RAILING AND FELL THREE FEEET AND LAC HEAD
PT FELL FROM A BANISTER/ LAC TO TONGUE
DENTAL INJURY AND CUT LIP WHEN FELL OFF HAND RAILING
FELL OFF A BANISTER TIB/FIB FX
CLIMBING ON DECK RAILING AND FELL 1 CM LOWER LIP LACERATION
@ HOME @ TOP OF STAIRS LEANING ON RAILING & FELL APX 10-12', UNSURE IF LANDED ON C
FELL OVER BANNISTER ONTO HARDWOOD FLOOR STEPS. DX HEMATOMA HEAD
FELL DOWN STAIRS OVER RAILING. DX ABRASION HEAD
FELL DOWN STAIRS OVER 2ND STORY BANNISTER, HIT CHIN ON RAILING, MANDIBL E FX
All these cases happened at home or in unknown locations. The estimate
associated with these cases is 579 injuries treated in hospital emergency
rooms for similar injuries in 2006. Nine of these injuries were associated
with banisters that were not included in the analysis provided in Appendix
B. When these cases were eliminated, we were left with 21 cases and an
estimate of 369 that is very close to the annual estimate of 354 injuries
provided in Appendix B. There are several factors that can account for
differences in the annual estimates for different years:
-
Sampling variation
Different interpretations of whether a case should be counted
Normal year to year differences in injury totals
Changes in the level of detail in the source documents from
some hospitals in different years
It is also important to note that any estimate that relies on this kind of
character string searching through incomplete source documents is likely to
be lower than the number of incidents that might be identified through a
complete count of incidents from a thorough census of all emergency
department visits..
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The most important point is that despite the slightly different approach and
the factors listed above, the estimates from my analysis of the 2006 data and
the analysis in Appendix B provide remarkably similar estimates.
In general, the analysis in Appendix B and its use in the document, “Review
of Fall Safety of Children Between the Ages of 18 Months and 4 Years in
Relation to Guards and Climbing in the Built Environment” December 2007
Edition are appropriate uses of the NEISS and the presentation is an accurate
description of the information.
Sincerely,
Arthur K McDonald
Consultant
Former Director – Division of Hazard and Injury Data Systems,
US Consumer Product Safety Commission
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PEER REVIEW: Christine A. Readdick
A Peer Review of
“Review of Fall Safety between the Ages of 18 Months and Four Years in
Relation to Guards and Climbing in the Built Environment”
April 17, 2008
At the behest of NOMMA (The National Ornamental & Miscellaneous
Metals Association) researchers Hedge, Kenney, and Davis (2007) have
assessed what is currently known about the safety of young children in relation to
guards in a residential setting. The research team has provided a
comprehensive assessment, comprised of a presentation of building code
requirements for guards (U.S., Canada, Australia, and New Zealand), a critical
review of published, peer-reviewed research articles regarding children’s
development and climbing skills, and critique of child fall and injury data garnered
from the U.S Consumer Product Safety Commission.
In Executive Summary, the authors conclude that “Results from either the
research studies or the injury data are neither specific enough to constitute a
solid basis for building code requirements” (p. 1v). I concur, after multiple
readings and reflection. In general, building codes for design and installation of
guards are varied; no study of children’s climbing has been conducted under
natural circumstances in children’s own homes, much less homes with the guard
design features of interest; and CPSC data is largely devoid of the contextual
information which would allow the reader to know where, with whom, and under
what circumstances an injury in the home occurred.
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Nonetheless, it is still possible to assert from the research available, as
the authors do, that a higher guard is better than a lower one, that design
features such as a hard-to-grasp railing, vertical members, and openings too
small for bare toes or shoes are best. And continued research is rightfully called
for regarding children’s safety and consideration, as given here to characteristics
of the child, the built environment, as well as elements of the family caregiving
system including appropriate child supervision.
I do have some encouragements beyond those offered by the authors. I
will center most of these remarks around young children themselves. First of all,
we must remember that children are not only uniquely and physiologically
capable of climbing, based on their abilities to rotate their arms up and over their
heads (as do other species which climb) but also that when one is small, even
more elements of the built and natural environment “pull for” or “afford” climbing,
because there are simply more things taller than the child herself--from
bookshelves to sides of cribs to guard rails. In saying this, I am simply
underscoring the fact that the ability and need to climb cannot be realistically
eliminated.
Further, my lifetime of experience with caregivers tells me that adults tend
to underestimate children’s physical prowess, as well as children’s abilities to
protect themselves. From this perspective, future research is needed to capture
the extent of children’s climbing experience vis-à-vis accidents from falls. My
hunch is that children who have ample, if not safe, opportunities for climbing will
be better able to protect themselves and be underrepresented in accident data.
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Given that children (some) begin climbing before they walk and before their first
birthday, I also recommend that future examination of CPSC fall data capture
accidents from at least 12 months on.
Certainly this review provides a strong rationale for education in families
and communities regarding children’s children’s climbing abilities and could
perhaps contribute to a public health dialogue regarding simple and inexpensive
means of retrofitting residences built before the most recent standards for guard
rails, with taller guard rails with smaller openings and vertical railings as a means
of reducing death and injury, in the way that New York reduced accidents by
installing steel metal screens on window openings. In my mind, beyond the
contribution of the active child and a less than perfect built environment, the most
important ingredient in the prevention of accidents entails the contribution of
vigilant adult supervision; it is not simply an issue of educating the child.
Little children are simply dependent on attentive adults for protection and
security. Accordingly, parents need to be informed under what circumstances a
fall from climbing is “waiting to happen”. That many accidents affect the poor and
ethnic minority children disproportionately places a burden of care on low-income
residential property owners and managers to abate risk (install more effective
guard rails) and inform residents about known risks that cannot be eliminated
and therefore will require increased adult vigilance. Relative to this same point,
as when I teach child guidance, property owners and parents alike need to
provide “legitimate” objects for climbing so that the issue becomes one of
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promoting children’s climbing of appropriate objects in the home environment
(indoors and out), rather than trying to prevent climbing from occurring at all.
For those of us who have shuddered to discover a preschooler flawlessly
scaling a chain link fence in a matter of seconds, the research cited in this review
and conducted by Rabinovich et al (1994) should be of considerable interest to
NOMMA. If indeed, future research with larger and representative samples of
young children confirm that an ornamental iron guard with vertical members 3
and one-half inches apart and a 45-inch gap between members (and at least 48
inches in height) is a significant deterrent to children’s climbing of and falls from
guard rails, then this may become the standard element recommended in new
home construction. In the case of the climbing young child, materiality in the
form of metal may be one of the most important deterrents to climbability of
guard rails.
In sum, Hedge, Kenney, and Davis have remained close to all of their data
(building codes, child climbing performance, and reports of accidents from falls)
and not overstated in any way the conclusions that they have reached or
recommendations they have made. Certainly, the recommendations to improve
consistency of language in building code standards, to conduct research of
children climbing naturally in their home environments, and to revise Consumer
Product Safety Commission hospital accident report forms to capture more social
and physical environmental features surrounding each incident are not only
accurate but demonstrably warranted in this excellent report.
Respectfully completed and submitted by Dr. Christine A. Readdick
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PEER REVIEW: Kimberly E. Stone
April 17, 2008
Thomas Kenney , P.E.
Vice President Engineering & Research
NAHB Research Center
400 Prince George’s Blvd.
Upper Marlboro, MD 20774
Dear Mr. Kenney:
Per your request, I have completed a review of your report entitled “Review Of Fall
Safety Of Children Between The Ages 18 Months And 4 Years In Relation To Guards
And Climbing In The Built Environment”-December 2007 Edition. I completed this
review from the perspective of a pediatrician with experience in designing and
conducting research in injury prevention, specifically falls from windows. I focused my
review on the following sections of the report: pp.6-7 (US Fall Injury Data), pp.26-40
(Children’s Interaction with the Built Environment) and Appendix B (NEISS Injury Data
Analysis). I have also included comments on the Abstract, Executive Summary and the
Conclusions.
The Abstract presents a summary of the purposes of the report, which include the
summary of code requirements, critical review of the literature on guard research and
injury data and analysis of available injury statistics. The objectives are clearly stated
and remain consistent throughout the report. Although these issues were addressed later
in the report, the fact that the term “guard” is not defined in the abstract is confusing.
Additionally, the 0.032% injury rate for falls from guards stated in the abstract has no
meaning initially because it is not reported in a “per population per year” format nor is it
placed into context by comparing to other statistics, such as homicides or motor vehicle
collision data.
The Executive Summary clearly defines who commissioned the report and its purpose.
The term “guard” is defined more explicitly in this section. When discussing injury data,
it would have been helpful to include the name of the data set used in the analysis in the
summary. When discussing the literature review, the credibility of the review would be
strengthened by discussing the inclusion/exclusion criteria and what search terms and
databases were used. The literature review was quite broad and the limitations of
conducting such a review should have been acknowledged. The literature review
encompasses a vast amount of information, including child development, guard design
and injury data. Inclusion of dates of review and the amount of time spent reviewing
literature would have put the scope of the review in perspective.
Based on my knowledge of the literature, the review of the epidemiology of falls from
heights is fairly complete, however there were several studies from the 1970’s and 1980’s
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that were not discussed (see Stone etal in your report for references). Discussing and
referencing the original New York window fall literature 9 would have strengthened the
review. The report mentions that many of the studies, especially in the review of fencing
design and climbability of structures, had quite small sample sizes. I am not sure it
would be possible, but was the possibility of pooling data and conducting a metanalysis
considered? Also, please make sure you check the completeness of your reference list.
There was one study that you quoted that was not mentioned in your reference list.
It was stressed that the literature reports fall incidences in localized areas and that these
rates are considerably higher than that derived from the NEISS data. Reasons for this are
not fully discussed. One possibility is that the research is carried out in areas with high
incidences of this, which is certainly true considering that most research is carried out in
urban areas with high buildings. I would argue that the NEISS may underestimate the
true burden of falls from guards for several reasons. One reason which was stated, is that
the coding of the NEISS is not conducive to identifying these falls. Also, since little
research has been done on the target area of falling from a guard, the fall rates reported in
the literature (mostly stairs and windows), does not reflect the actual incidence of falls
from guards. Also, many injuries resulting from falls from guards may be treated in
urgent care centers, primary care providers’ offices or not brought to medical attention
for a variety of reasons. Even though these falls may be less severe since the victims are
not seen in an emergency room or hospital, they may still contribute substantially to the
economic burden of injury in medical costs and lost income 10.
Appendix B, though lengthy, provided an excellent review of how the injury data was
obtained from the NEISS Data Set. It allows the reader to replicate the process of
obtaining the data. It also emphasizes the possible changes that could be made to the
coding process to allow cleaner use of the data. The inclusion of all the case numbers
could possibly have been deleted from the report but available on request. It would also
be helpful to compare these rates to other, established rates for other injuries.
The conclusions regarding a lack of data regarding guard design features is certainly
appropriate. Emphasis is appropriately placed on the fact that there is no research
regarding “guards” as defined in this report. However, attention should be paid to the
fact that the age of the child seems to be an important factor, since most falls occur in
ages 1 to 4, and the fact that after the age of four it seems that few fencing designs can
prevent climbing. Examining the fencing designs deemed “unclimbable” by younger
children should certainly provide a starting point for guard design.
One concern I have is that emphasis is placed on the child climbing over the guard and
falling. There was no mention of the possibility of a child attempting to climb a guard
and falling while failing to climb it. In the studies conducted regarding climbability of
guards, great attention was paid to preventing children from falling during the study and
9
Spiegel etal. Children Can’t Fly: A Program to Prevent Childhood Morbidity and Mortality from Window
Falls. Am J of Public Health; 1977;67:1143-1146.
10
Zaloshnja etal, The Costs of Unintentional Home Injuries, Am J of Prev Med; 2005;28:88-94.
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PEER REVIEW: Kimberly E. Stone
they did not report if falls occurred when children failed to climb the guard. It is
certainly possible that falling backward from the guard could cause as much injury as
falling over the guard, and this should be considered when designing guards.
The American Academy of Pediatrics’ policy statement on prevention of falls is
appropriately cited when discussing the importance of injury prevention 11. There is also
an impressive amount of literature in the health education literature regarding health
promotion and education, as well as the interaction between legislation and individual
and community education. I encourage you to read articles by Andrea Gielen, ScD on
this topic. Another report of interest is the report “Built Environment, Healthy
Communities, Healthy Homes, Healthy People” which reports on a symposium
sponsored by the NIEHS. While it is true that counseling can increase some injury
prevention behaviors, the most effective injury prevention strategies are those that
involve legislation and passive protection 12
I hope this review has been helpful to your organization. If you have any questions,
please feel free to contact me at [email protected].
Sincerely,
Kimberly E. Stone, MD, MPH
Fellow, American Academy of Pediatrics
Member, Section on Injury and Poison Prevention
11
Bull etal, Falls from Heights: Roofs, Windows and Balconies, Pediatrics; 2001;107:1188-1191.
Sleet, D, Schieber, R and Gilchrist, J. Health Promotion Policy and Politics: Lessons from Childhood Injury
Prevention, Health Promotion Practice, 2003;4:103-108.
12
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CURRICULUM VITAE: Arthur K. McDonald
Arthur K. McDonald
16512 Montecrest Lane
Darnestown, MD 20878
H (301) 869-4153
Email: [email protected]
Employment History
●
Consultant, National Center for Statistics and Analysis,
National Highway Traffic Safety Adninistration
●
Director, Division of Hazard and Injury Data Systems,
US Consumer Product Safety Commission (CPSC)
1980-2004
●
Special Assistant to Associate Executive Director, CPSC
1976-1980
●
Statistician, Office of Planning and Evaluation, CPSC
1974-1976
●
Mathematician, US Public Health Service, DHHS
1969-1974
●
Commissioned Officer, US Public Health Service,
Department of Health and Human Services (DHHS)
1967-1969
●
Teaching Fellow - Mathematics, Boston University
1964-1967
2004-Present
Education
●
Master of Philosophy (Mathematical Statistics) - George Washington University 1970
●
Master of Arts (Mathematics) -
Boston University
1967
●
Bachelor of Arts (Mathematics)
Bowdoin College
1964
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CURRICULUM VITAE: Christine Andersen Readdick
CHRISTINE ANDERSON READDICK
Department of Family and Child Sciences
206 Sandels Building
32308
The Florida State University
Tallahassee, Florida 32306-1491
(850) 644-6849
2550 Noble Drive
Tallahassee, Florida
(850) 385-5335
(850) 644-3439 Fax
[email protected]
EDUCATION
Ph.D. THE FLORIDA STATE UNIVERSITY, Tallahassee, Florida, 1988.
Major: Child Development.
Dissertation: The Effects of Cooperation, Competition, and Friendship
on Children's Social Comparisons.
M.S.
THE UNIVERSITY OF GEORGIA, Athens, Georgia, 1976.
Major: Child and Family Development.
Thesis: Social Comparison Processes in Mother-Child-Sibling
Interaction: Effects on Mother-Child-Sibling and Child-Peer
Interaction.
B.A.
MEMORY UNIVERSITY, Atlanta, Georgia, 1968.
Major: Elementary Education.
ADDITIONAL EDUCATION
Westminster Choir College, Princeton, New Jersey, July 1980. Coursework in
Introductory Orff-Schulwerk completed.
Virginia Polytechnic Institute and State University, Dulles, Virginia, July-August 1979.
Coursework in Measurement and Instrumentation completed.
The Pennsylvania State University, University Park, Pennsylvania, 1976-1977. Ph.D.
candidacy approved, 1977. Coursework in Individual Development and Family
Studies completed.
Weber State College, Ogden, Utah, 1971-1973. Coursework in Child Development
completed.
Goethe Institute, Schwabisch Hall, Germany, March-May, 1970. Basic German language
certificate awarded.
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PROFESSIONAL
EXPERIENCE
Associate Professor - Department of Family and Child Sciences. 5/94-present;
Assistant Professor 12/88 - 5/94; (Adjunct Instructor 10/87-12/88). College of
Human Sciences, Florida State University, Tallahassee, Florida 32306
Assistant Professor - Department of Education. 8/79 - 8/81 (Instructor 8/78 - 8/79).
Director, Onica Prall Child Development Center. 12/79-5/81 (Head Teacher
9/78 - 12/79). Hood College, Frederick, Maryland 21701
Assistant Professor - Department of Child and Family Studies. Director, The Children's
School. 9/77 - 6/78. Weber State College, Ogden, Utah 84401
Graduate Teaching Assistant - The Cognitive Development Program, Laboratory for
Early Education, Division of Individual and Family Studies. 9/76 - 6/77. College
of Human Development, The Pennsylvania State University, State College,
Pennsylvania 16802
Graduate Teaching Assistant - The Infant Center, McPhaul Child Development Center.
9/75 - 12/75. Graduate Research Assistant. 9/74 - 9/75. Department of Child
and Family Development, The University of Georgia, Athens, Georgia 30602
Substitute Teacher - Kodiak Borough Schools. 2/74 - 8/74. Kodiak, Alaska 99615
Lecturer - Family Life Department. 1/73 - 8/73. Head Teacher, The Children's School.
Weber State College, Ogden, Utah 84401
Educational Coordinator - Project Head Start. 9/71 - 6/72. Teacher. 9/72 - 12/72.
Ogden, Utah 84401
Director/Head Teacher - Utah Migrant Council Summer Day Care Center. 6/71 - 8/71.
Layton, Utah 84041
Substitute Teacher - U.S. Army Schools, Europe. 3/70 - 6/70. Schwabisch Hall,
Germany
Teacher - St. Simons Elementary School. 8/69 - 11/69. St. Simons Island, Georgia
31522
Teacher - James Mayson Elementary School. 1/69 - 6/69. Atlanta, Georgia 30321
Teacher - Peyton Forest Elementary School. 8/68 - 12/68. Atlanta, Georgia 30311
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CURRICULUM VITAE: Christine Andersen Readdick
PROFESSIONAL
MEMBERSHIPS
Groves Conference on Marriage and the Family (invited member)
American Association of Family and Consumer Sciences
International Federation of Home Economics
National Association for the Education of Young Children
Southern Early Childhood Association
Early Childhood Association of Florida
Society for Research in Child Development
Concerned Educators Allied for a Safe Environment
Association for Childhood Education International
National Council on Family Relations
National Organization of Child Development Laboratory Schools
Jean Piaget Society
World Organization for Early Childhood Education (invited member)
The American Association for the Child’s Right to Play (IPA/USA)
PROFESSIONAL
ACTIVITIES
President-Elect, Groves Conference on Marriage and Family, 11-07-6-08; President,
2008-2011.
2008 Ireland Conference Chair, Groves Conference on Marriage and Family, 20062008.
Membership Chair, Groves Conference on Marriage and Family, 4/05-4/08.
Editorial Consultant, Dimensions of Early Childhood, Southern Early Childhood
Association, 12/93-present.
Past President, Leon Association for the Education for the Education of Young Children,
5/05-06. (President-Elect 3/02-5/03; President 5/03-05/05).
Member, Publications Committee, Early Childhood Association of Florida, 8/02-present
(Chair 8/02-8/04).
Editorial Consultant, Young Children, National Association for the Education of Young
Children, 11/95-12/98.
Faculty Advisor, The Florida State University Association for the Education of Young
Children, 9/88-4/99.
Faculty Advisor, Kappa Omicron Nu, Florida State University, 9/90-8/92; 9/00-5/04.
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CURRICULUM VITAE: Christine Andersen Readdick
HONORS AND
AWARDS
Centennial Laureate, College of Human Sciences, The Florida State University, 2005.
2005 Advocacy Award, The Early Childhood Association of Florida and the Leon
Association for the Education of Young Children.
Business Associate Award, American Business Women's Association, Tallahassee, 1995.
Teaching Incentive Award, College of Human Sciences, The Florida State University,
1994-1995.
College Teaching Fellow, College of Human Sciences, The Florida State University,
1985-1986.
Delta Kappa Gamma, Honor Society in Education, 1989.
Omicron Nu, Honor Society in Home Economics, 1986.
Gamma Sigma Delta, Honor Society in Agriculture, 1976.
Kappa Delta Epsilon, Honor Society in Education, 1986.
FUNDED RESEARCH
ACTIVITIES
Mary Francis Hanline and Christine Readdick, Preservice Preparation of Highly Qualified
Early Intervention Specialists, U.S. Department of Education, $249,000, Fall
2007.
Christine Readdick, Child Care Center Noise: Measurement, Effects, and
Recommendations, Florida State University COFRS Award, $13,000, Summer
2007.
Mary Francis Hanline and Christine Readdick, Preservice Preparation of Highly Qualified
Early Intervention Specialists, U.S. Department of Education, $249,000, Fall
2006.
Mary Francis Hanline and Christine Readdick, Preservice Preparation of Highly Qualified
Early Intervention Specialists, U.S. Department of Education, $249,000, Fall
2005.
Mary Francis Hanline and Christine Readdick, Preservice Preparation of Highly Qualified
Early Intervention Specialists. U.S. Department of Education, $249,000, Fall
2004.
Mary Francis Hanline and Christine Readdick. Preservice Preparation of Highly Qualified
Early Intervention Specialists. U.S. Department of Education, $249,999, Fall
2003.
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CURRICULUM VITAE: Christine Andersen Readdick
Catherine Black and Christine Readdick. The Effects of Costuming on YoungChildren’s
Story Retelling Abilities. College of Human Sciences Research Initiation Award,
$1,000, Spring 2003.
Christine Readdick. Noise Abatement: A Missing First Step in Early Literacy Programs.
Florida Children’s Forum, $10,000, Fall 2002.
Christine Readdick (Principal Investigator) and Penny Ralston. The Gwen Cherry Child
Development Center Community Partnership Project, Florida Department of
Education, $18,900, Summer 2002.
Christine Readdick. Foster Grandparents: Key to Intergenerational Programming at
Gwen Cherry Child Development Center. Leon County School Readiness
Coalition, $1,500, Spring 2002.
Christine Readdick and Brittany Birkin. “Reading to Your Bunny”: Family Literacy at
Gwen Cherry. Kids Incorporated of the Big Bend Caring for Kids Mini-Grant,
$300, Spring 2002.
Christine Readdick (Principal Investigator) and Penny Ralston. The Gwen Cherry Child
Development Center Community Partnership Project, Florida Department of
Education, $37,000, Fall 2001.
Christine Readdick (Principal Investigator) and Penny Ralston. The Gwen Cherry Child
Development Center Community Partnership Project, Florida Department of
Education, $393,000, Fall 2000.
Christine Readdick (Principal Investigator), David Wright, and Penny Ralston. The Gwen
Cherry Child Development Center Community Partnership Project, Florida
Department of Education, $630,000.00, Fall 1999.
Christine Readdick (Principal Investigator), Catherine Black, Kaye Grise, and Jeanne
Heitmeyer. Florida’s Children: Sun Protection. Florida State University, College
of Human Sciences RIAP Grant, $2,000, Spring 1998.
E. Wayne Hill, Ronald L. Mullis (Principal Investigators), Christine Readdick, and Connor
Walters-Chapman: Parent and Adolescent Caring Connections. Lilly Endowment,
Inc. $35,000, Fall 1993.
E. Wayne Hill (Principal Investigator), Ronald L. Mullis, Christine Readdick, and Connor
Walters-Chapman. An Intergenerational Comparative Study of Parent and
Adolescent Attachments. College of Human Sciences Individual Research
Initiative, $8,000, Fall 1993.
Jeanne Heitmeyer (Principal Investigator), Kay Grise, and Christine Readdick. Selection,
Acquisition, and Care of Children's Clothing in Single-Parent and Dual-Parent
Families. Kappa Omicron Nu Research Grant, $1,000, Spring 1992.
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CURRICULUM VITAE: Christine Andersen Readdick
Betty Jo Troeger (Principal Investigator) and Christine Readdick. Development of the
ART Scale: A Measure of Children's Drawing Skills. Florida State University
COFRs Grant, $7,500, Summer 1990.
Christine Readdick (Principal Investigator). Adolescent Caregiving of Siblings and NonSiblings. Florida State University Council on Research and Creativity First Year
Assistant Professor Award, $1,000, Summer 1989.
REFEREED
PUBLICATIONS
Note. *Master’s student, **doctoral student.
Fairbrother, J.T., Readdick, C. A., Shea, J.B (Winter 2008). A human factors approach
to the forensic investigation of a portable crib collapse. Ergonomics in Design.
Purvis-Montford, E.*, & Readdick, C. A., (in press). Puzzlemaking and part-whole
perception of two- and four-year-old children. Early Child Development and Care.
Analysis of variance and descriptive statistical analysis techniques indicated that
older preschoolers were more successful puzzlemakers and had greater partwhole perception abilities, than younger preschoolers, among 100 subjects
tested; children reported by their parents as spending more time playing with
puzzles at home were more skillful puzzlemakers.
Levy-Tacher, E.* & Readdick, C.A. (2006). The relation between aggression and
creativity among second graders. Creativity Research Journal, 18(3), 261-267.
Pearson product moment correlations suggested a positive relationship between
verbal aggession and fluency, flexibility, and originality of the Verbal Torrance
Test of Creative Thinking (TTCT), between threats of aggression and verbal
flexibility, and between physical aggression and figural flexibility ( Figural TTCT)
among 32 young children observed and tested in their elementary school.
Readdick, C.A. (2006). Noise and its management in early childhood settings.
Dimensions of Early Childhood, 34(1), 17-22.
Outlines the science of hearing, reviews research on the effects of noise on the
human young and measurements of noise in early care and education
environments, and recommends means for reducing physical and social
environmental noise in these settings.
Readdick, C.A. & Schaller, R.* (2005). Summer camp and self-esteem of school-age
inner-city children. Journal of Perceptual and Motor Skills, 101, 121-130.
T-tests indicated significant increases in 68 school-age inner-city children’s
overall self-esteem and perceptions of popularity from beginning to end of a brief
summer camp. E.O. Wilson’s theory of biophilia is used as an organizer of
qualitative data collected through selected child interview and participant
observation to explain the possible contribution of nature to self-esteem.
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CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A. (2005). Is its just me or is it noisy in here? Sound management in early
care and education settings. Texas Child Care Quarterly, 28(4), 4-42.
Provides a brief sound survey to be used by educaregivers to identify sources
and intensity of noise in the child care environment and offers simple noise
abatement strategies.
Marty, A.**, Readdick, C.A. & Walters, C. (2005). Supporting secure parent-child
Attachments: The role of the non-parental caregiver. Early Child Development
and Care, 175(3), 271-283.
The theory of attachment of Bowlby, the bioecological theory of Bronfenbrenner,
and a review of the scientific literature regarding parent-child attachment and
non-parental caregiver-child attachment combined with best practices in early
care and education provide a practical framework for the consideration of the role
of the non-parental caregiver in the promotion and support of secure parent-child
attachments during infancy and toddlerhood.
Lazar, R.* & Readdick, C.A. (2004). Environmental education in a Florida sinkhole.
Children Our Concern, 27(1), 11-15.
Presents Florida’s hundreds of thousands of sinkholes as compelling and
scientifically significant geological structures appropriate for safe, hands-on
exploration and offers activities for learning for preschool and school-age
children.
Thackeray, A. M.* & Readdick, C.A. (2003). Preschoolers’ anatomical knowledge of
salient and non-salient sexual and non-sexual body parts. Journal of Research in
Childhood Education, 18 (2), 141-148
Analysis of variance and descriptive statistical procedures indicated that 99 fouryear-old children demonstrated greater knowledge of salient than non-salient
body parts and that most used slang terms or failed to label sexual body parts of
a same-gender anatomically correct doll.
Black, C., Grise, K. S., Heitmeyer, J. R., & Readdick, C. A. (2001). Sun protection:
Knowledge, attitude and perceived behavior of parents and observed dress of
preschool children. Journal of Family & Consumer Sciences Research Journal,
30 (1), 93-109.
Description statistics indicated that among 100 preschoolers observed during
summertime outdoor play at selected childcare centers few wore sun protective
apparel counter to their parents’/guardians’ high and significantly, positively
correlated sun protection knowledge, attitudes, and perceived behaviors.
Contemporaneous observations in 15 retail stores revealed a limited supply of
sun protective apparel products for children.
Readdick, C.A. & Chapman, P. (2000). Preschoolers’ perception of time out. Journal of
Research in Childhood Education, 15 (1), 81-87.
Chi square analysis indicated largely negative self-attributions expressed by 42
preschoolers subsequent to a time-out experience, including feeling alone,
disliked by one’s teacher, and ignored by one’s peers.
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CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A. & Chapman, P. (2002). Preschoolers’ perception of time out. In M.L.
Patten (Ed.) Evaluation and psychological research: A cross section of journal
articles for analysis and evaluation. Los Angeles, CA: Pyrczak Publishing.
Readdick, C. A. & Douglas, K. (2000). More than line leader and door holder:
Engaging young children in real work in the early childhood setting. Young
Children, 55 (6), 63-70.
Develops an ecological perspective for the consideration of children’s work with adults,
reviews literature on children’s work, and offers recommendations for inclusion of
opportunities for child work in early childhood settings, based on interviews with
81 child care directors and descriptive statistical analyses.
Hill, E. W., Mullis, R. L., Readdick, C. A., & Walters, C. M. (2000). Intergenerational
perceptions of attachment and prosocial behavior. Marriage & Family Review,
30 (1/2), 59-72.
Multivariate analyses of variance and paired T-tests indicated perceptions of
maternal attachment were greater for female adolescents than mothers and
greater for maternal grandmothers than mothers among 117 family triads.
Mothers reported greater prosocial behavior than adolescents and grandmothers.
Mullis, R. L., Hill, E. W., & Readdick, C. A. (1999). Attachment and social support
among adolescents. Journal of Genetic Psychology, 160 (4), 500-502.
Multivariate analyses of variance indicated that high perceived social support
from friends and relatives is associated with perceived attachment to mothers,
especially for younger adolescents, among a sample of 615 male and female
adolescent, ages 15-21.
Readdick, C. A. & Park, J.*, (1998). Achieving great heights: The climbing child. Young
Children, 53 (6), 14-19.
Reviews research regarding development of climbing abilities in early childhood,
develops rationale for the inclusion of opportunities for climbing in early childhood
environments, and offers recommendations for caregiver activity and
environmental design.
Readdick, C.A. & Mullis, R.L. (1997). Adolescents and adults at the mall: Dyadic
interactions. Adolescence, 32 (126), 313-322.
Chi square analysis indicated differences in conversation and shopping evidence
between 865 teen-teen dyads and 190 teen-adult dyads as well as several
gender and racial differences in within teen-teen dyad comparisons.
Heitmeyer, J.R., Grise, K.S., & Readdick, C.A. (1997). Selection and acquisition of
children's clothing in single-parent and dual-parent families. Journal of Fashion
Marketing and Management, 1 (4), 333-341.
One-way analysis of variance procedures were employed to reveal only
differences in lack of money and in method of payment for purchase of children's
clothing between 247 single-and dual-parent families with school-age (K-12)
children.
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CURRICULUM VITAE: Christine Andersen Readdick
Hill, E.W., Mullis, R.L., Readdick, C.A., & Walters-Chapman, C.M. (1996). Family
connections and altruism: Intergenerational perceptions. Family Science
Review, 9 (3,4), 249-261.
Analysis of variance and Pearson product moment correlations were used to
indicate neither perceptions of maternal nor paternal attachment in one
generation was predictive of that of any other generation for 33 triads of
adolescent daughters, mothers, and maternal grandmothers.
Readdick, C.A., Grise, K.S., Heitmeyer J.R., & Furst, M.H. (1996). Elementary schoolage children and their clothing: The development of self-perception and
management of appearance. Journal of Perceptual and Motor Skills, 82,
383-394.
Descriptive and chi square statistics indicated that the 223 children in
kindergarten through grade 5 expressed highly positive feelings about their
school clothing, that younger children had more positive appraisals of their own
clothes, as compared to their friends’ clothes, than older children, and that older
children were more involved in clothing purchase and care than younger children.
Readdick, C.A. (1995). Young children's symbol making tools and factors affecting their
selection use: An international survey. International Journal of Early Years
Education, 3(1), 93-100.
Descriptive statistics indicated standard size pencils and crayons are most
frequently available drawing and writing tools for young children in 41 countries
worldwide and that commercial tool availability was associated with human
development indices within countries.
Readdick, C.A. (1994). Toddlers and preschoolers drawing with primary and standard
pencils, markers, and crayons. Journal of Research in Childhood Education,
9(1), 68-74.
T-tests and Pearson product moment correlations were used to demonstrate the
similarity of grips and drawings produced with standard and primary instrument
and the relationship of early manipulative experience at home, such as cutting
with scissors, to children's more mature drawing performances and products.
Zeegers, S.K., Readdick, C.A., & Hansen-Gandy, S. (1994). Day care children's
establishment of territory to experience privacy. Children's Environments,
11 (4), 265-271.
Interviews with 100 randomly selected preschoolers in 10 child care centers
indicated that the majority of young children select special places for themselves,
establishing territory as a means for achieving privacy in their group child care
settings.
Ghazvini, A.S.* & Readdick, C.A. (1994). Parent-caregiver communication and quality of
care in diverse child care settings. Early Childhood Research Quarterly,
9, 207-222.
Analysis of variance and Pearson product moment correlations were used to
demonstrate that the frequency and importance of one-way, two-way, and threeway communications as perceived by 201 parents and 41 caregivers are related
to assessments of quality in 12 child care centers.
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CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A. & Mullis, R.L. (1994). The Playground Improvement Project: A model for
university and community collaboration. International Play Journal, 2, 155-163.
Affords university and child care center personnel a structure for working
together to enhance the safety and quality of outdoor play environments, based
on survey and three years of work with 33 child care centers.
Readdick, C.A. & Walters-Chapman, C. (1994). Designing and arranging child care
environments to promote parent-child attachment. Texas Child Care, 18(2), 2-7.
Provides a framework derived from theory, research, and practice for
consideration of the role of the caregiver promoting parent-child attachment
through design and arrangement of child care environments.
Readdick, C.A. & Bartlett, P.M. (1994). Vertical learning environments: Extending young
children's opportunities for play and learning in the early childhood classroom.
Childhood Education, 71(2), 86-90.
Offers a constructivist perspective and pedagogical framework for the use of
vertical surfaces arranged with 2- and 3-D objects that afford children
opportunities for perception, manipulation, interaction, construction of knowledge,
and representation.
Bradbard, M.R., Brown, E.G., Endsley, R.C., & Readdick, C.A. (1994). Parents’
selection of proprietary day care centers for their children: A study of three
southeastern university communities. Child & Youth Care Forum, 23(1), 55-72.
Analysis of variance and Pearson product moment correlations were employed to
reveal that neither demographic variables of 145 parents nor day care selection
variables were associated with parents' selection of better quality day care in 25
centers.
Readdick, C.A. (1993). Solitary pursuits: Supporting children's privacy needs in early
childhood settings. Young Children, 49 (1), 60-64.
Reviews literature on privacy and addresses why children need privacy, how
children seek privacy, factors influencing children's privacy needs, and how
adults can support children's privacy needs.
Readdick, C.A. & Walters-Chapman, C. (1993). Is play the centerpiece of your early
childhood curriculum? Early Child Development and Care, 81,123-129.
Presents early childhood educators with the values, means for identification, and
techniques to support practice, pretend, and constructive play.
Readdick, C.A. (1987). Schools for the American nanny: Training in-home child care
specialists. Young Children, 42(4), 72-79.
Describes the role of the nanny, presents programs of training of eleven
accredited nanny schools, and offers recommendations for elevating
professionalism in the in-home child care field.
NAHB Research Center
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May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A., Goldbeck, S.L., Klein, E.L., & Cartwright, C.A. (1984). The child-parentteacher conference: A setting for child development. Young Children, 39, 67-73.
Presents a rationale and working model for including children in parent-teacher
conferences and methods for helping children to become progressively active
decision-makers within the conference setting.
Readdick, C.A., Goldbeck, S.L., Klein, E.L., & Cartwright, C.A. (1984). The childparent-teacher conference: A setting for child development. In J. Brown (Ed.),
Administering Programs for Young Children. Washington, D.C.: NAEYC.
Endsley, R.C., Bradbard, M.R., & Readdick, C.A. (1984). High-quality proprietary daycare: Predictors of parents' choices. Journal of Family Issues, 5(1), 131-152.
Stepwise regression analyses were conducted to show that level of husband's
education and dissatisfaction with previous day care arrangements were among
significant predictors of 257 parents selecting a quality program in 18 licensed
centers.
Bradbard, M.R., Endsley, R.C., & Readdick, C.A. (1983). How and why parents select
profit-making day care programs: A study of two southeastern college
communities. Child Care Quarterly, 12(2), 160-169.
Interviews with 86 parents whose children attend six profit-making day care
centers indicated parents more likely to receive initial information about day care
from friends and neighbors and to visit prior to enrollment only the one program
their child attended.
Santrock, J.W., Readdick, C.A., & Pollard, L. (1980). Social comparison in sibling and
peer relations. The Journal of Genetic Psychology, 137, 91-107.
Analysis of variance procedures were performed to indicate that the social
behavior of 40 5-to-8 year-old boys was most disrupted when they received
fewer rewards from their mother in an experimental setting than their brother and
that, after "low" social comparison experiences with a peer confederate; 20 6-to-8
year-old girls engaged in more negative behavior and less socially competent
behavior with their sisters.
REFEREED PUBLICATIONS
PENDING REVIEW
Gilbert, P.** & Readdick, C.A. (under review). Marital satisfaction in forgiving and
unforgiving families. Journal of Marital and Family Therapy.
Hessell, S.* & Readdick, C.A. (under review). Parent and teacher perceptions of
children’s multiple intelligences. Journal of Research in Childhood Education.
Zeegers, S. K.** & Readdick, C. A. (under review). A content analysis of the Journal of
Home Economics, 1909-1994: A legacy of concerns for children. Family &
Consumer Sciences Research Journal.
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CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A. & Birkin, B.O.* (under review). Development of climbing in two young
children with Down syndrome. Journal of Perceptual and Motor Skills.
Readdick, C. A., & Alexander, E. K.* (under review). Social support networks and
parenting stress of stay-at-home mothers. Parenting: Science and Practice.
Mercer, N.W.* & Readdick, C. A. (under review). Developmentally appropriate naptime
practices for young children in group settings. Young Children.
Lee, K.G.*, & Readdick, C.A. (under review). Locus of control and self-esteem in
hospitalized children with cancer and sickle cell anemia. Child: Care, Health &
Development.
Readdick, C.A., Gatz, A.O., & Chatterjee-Graf, S. (under review). A longitudinal assay
of noise in one early care and education setting. Early Childhood Research
Quarterly.
Jianhong, R.** & Readdick, C.A. (under review). Ethnic identity, self-esteem and
depression among young Chinese adolescents residing in the United States.
Journal of Early Adolescence.
ARTICLES IN PREPARATION
Readdick, C.A. & Huffman, C. (in preparation). The Baby House: A design for
the Gwen Cherry Child Development Center Community Partnership Project.
Taliano, K. & Readdick, C.A. (in preparation). Young school-age boys’ running a foot
race and making social comparisons with friends and non-friends. Child
Development.
Readdick, C. A. (in preparation). Child care center design and programming for the 21st
century: A synthesis of home, school, and orphanage.
Readdick, C. A. (in preparation). The affordances of modeling compounds for
manipulation, construction of physical knowledge, and creativity.
Thackeray, A. D.** & Readdick, C. A. (in preparation). Children’s relational perceptions
of God.
Readdick, C. A., & Smith, L. T.*, (in preparation). The effects of cooperation,
competition, and friendship on young children's communicative behavior.
Readdick, C. A., & Fritzen, R. S.*, (under review). Supersitters: Adolescents who
provide extensive care for siblings and non-siblings.
Saxby, E.** & Readdick, C. A. (in preparation). Adolescent community service
involvement
NAHB Research Center
C-31
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Gatz, A., Peterson, G., Hicks, M. & Readdick, C. A. (in preparation). The Parent
Attachment Scale: A construct validity study.
Lampkin, C.* & Readdick, C.A. (in preparation). Bedtime rituals and behaviors:
Relationship to young children’s temperament, social acceptance, and social
competence.
Lin, H.*, & Readdick, C.A. (in preparation). Creativity and academic achievement
among Chinese and American preschoolers.
Hall, L.S.*, & Readdick, C.A. (in preparation). The mother-daughter relationship as
context for the development of adolescent daughter's body image, self-esteem,
and weight preoccupation.
Readdick, C.A, & Troeger, B.J. (in preparation). The effects of cooperation, competition,
and friendship on the artistic merit of children's drawings.
Readdick, C.A. (in preparation). Sibling and non-sibling caregiving experiences of
adolescents.
NONREFEREED PUBLICATIONS (INVITED)
Readdick, C.A. (2004). Foster Grandparents: Making a case for paid intergenerational
volunteers. Journal of Intergenerational Relationships, 2, (1).
Readdick, C.A. (2003). Is it just me or is it noisy in here? Sound and its management in
early childhood education and care settings. Florida Children’s Forum.
Readdick, C.A. (2003). Noise and its management in early childhood settings: A
technical assistance manual. Florida Children’s Forum Technical Assistance
Paper Series.
BOOK CHAPTERS UNDER REVIEW
Readdick, C. A. & Douglas, K. (under review). Engaging young children in real
work. In Nimmo. J. (Ed). In real life: Connecting young children to the
wider world of adults in the community. Teachers College Press.
BOOKS UNDER REVIEW
Readdick, C.A. (under review). What can baby do? Peachtree Press.
Readdick, C. A. (under review). One girl’s day: A specimen record of behavior,
Oxford University Press.
NAHB Research Center
C-32
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Readdick, H. & Readdick, C.A. (under review). Good day sun, Houghton Mifflin.
Readdick, C. A., Winegard, N. & Valenza, V. (under review). It’s in the Bag:
Single portion cooking with young children, Southern Early
ChildhoodAssociation.
Readdick, C.A. & Mercer, N.W. (under review). More it’s in the bag: Single
portion cooking with young children, (under review) Southern Early
Childhood Association.
Readdick, C.A. & Coble, D. N. (under review). Where does it grow? A first book
of foods and cooking for young children, Pleasant Company Publications.
BOOKS IN PREPARATION
Readdick, C. A. & Douglas, K. Arts and crafts for young children.
Readdick, C.A. Paying attention to children: A child study guide.
Readdick, C.A. Child guidance for democratic living in a changing world.
Mullis, R.L., Mullis, A. & Readdick, C.A. Middle childhood: Development in
context from five through twelve years of age.
VIDEOTAPES IN PREPARATION
Readdick, C. A. & Purvis-Montford, E. (in preparation). Teachable Moments.
Readdick, C. A. & Purvis-Montford, E. (in preparation). Transitions.
Readdick, C. A. & Purvis-Montford, E. (in preparation). Trust.
VIDEO TAPE REVIEWS
Readdick, C.A. (1995). Different and the same by Susan Linn, Dimensions of
Early Childhood.
BOOK REVIEWS
Readdick, C.A. (in press). Collaborative treatment of traumatized children and
teens: The trauma systems therapy approach. By Genn N. Saxe, B. Heidi
Ellis, & Julie B. Kaplow, in Traumatology.
NAHB Research Center
C-33
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A. (Fall 2005). Extracting lessons on VPK from Bowling alone: The
collapse and revival of American community, by Robert D. Putnam, in
Florida’s Child, 5(2), 26-27.
Readdick, C.A. (Summer 2005). Starting out right: A guide to promoting
children’s reading success, edited by M. Susan Burns, Peg Griffin, &
Catherine E. Snow, in Florida’s Child, 5(1), 29-30.
Readdick, C.A. (Spring 2005). Taking one step at a time: A review of When your
child has a disability: The complete sourcebook of daily and medical care,
edited by Mark L. Batshaw, in Florida’s Child, 4(4), 29-31.
Readdick, C.A. (Winter 2005). Leave no child behind: Preparing today’s youth
for tomorrow’s world, by James P. Comer, in Florida’s Child, 4(3), 29,31.
Readdick, C.A. (Fall 2004). All work and no play—How educational reforms are
harming our preschoolers, by Sharna Olfman, in Florida’s Child,
4(2), 30-31.
Readdick, C.A. (Summer 2004). Just talk, Florida: Reflections on Meaningful
differences in the everyday experience of young American children and
The social world of children learning to talk, by Betty Hart and Todd R.
Risley, in Florida’s Child, 4(1), 29-31.
Readdick, C. A. (Winter 2004). The first three years & beyond: Brain
development and social policy, by Edward Zigler, in Florida’s Child,
3 (3), 25.
Readdick, C. A. (Fall 2003). Time to care: Redesigning child care to promote
education, support families, and build communities, by Joan Lombardi in
Florida’s Child, 3 (2), 31.
Readdick, C.A. (1997). Literacies lost: When students move from a progressive
middle school to a traditional high school, by M. Cyrene Wells in the
Journal of Adolescence, 20, 343-349.
Readdick, C.A. (1996). Child play: Its importance for human development, by
Peter Slade in The American Journal of Family Therapy, 24 (2), Summer
1996.
Readdick, C. A. (1995). How to talk to your kids about really important things, by
Charles E. Schaefer & Teresa Foy DiGeronimo in The American Journal
of Family Therapy, 23 (1), Spring 1995.
NAHB Research Center
C-34
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
INTERNATIONAL
REFEREED
PRESENTATIONS
Readdick, C.A. The geosystem and globalization: Differential effects of the natural
environment on child and family well-being. Groves Conference on Marriage and
Family, Ireland, June 2008.
Readdick, C. A. & Robinson, J.K. Oklahoma City eastside children’s neighborhood
mappings: Representations of risk and resilience in the physical and social
environments. Groves International Conference on Marriage and the Family,
Oklahoma City, Oklahoma, May 2004.
Readdick, C. A. Escuela Ricardo Diaz Rodriguez: Young children and the “natural
elements”. Groves International Conference on Marriage and the Family, Miami,
Florida, June 2003.
Readdick, C. A. & Thackeray, A. D. Children’s relational perceptions of God: Stories
and portraits of selected preschoolers, school-agers, and adolescents. Groves
International Conference on Marriage and the Family, Chautaugua, New York,
June 2002.
Readdick, C. A. & Alexander, E. K. Social support networks and parenting stress of stayat-home mothers. Groves International Conference on Marriage and the Family,
Ashville, North Carolina, June 2000.
Levy-Tachter, E. & Readdick, C.A. The relationship of creativity and aggression in
selected second graders. Annual Symposium of the Jean Piaget Society, Mexico
City, June 1999.
Grise, K. S., Black, C., Heitmeyer, J. R., & Readdick, C. A. Sun protective clothing for
young children in preschool settings. International Textile and Apparel
Association Annual Meeting, Santa Fe, November 1999.
Readdick, C. A., Children’s work and play in declining economies. Groves International
Conference on Marriage and the Family, Digby, Nova Scotia,
June 1997.
Heitmeyer, J.R., Grise, K.S., & Readdick, C.A. Selection and acquisition of children’s
clothing in single-parent and dual-parent families. International Textile and
Apparel Association, Annual Meeting, Pasadena, November 1995.
Readdick, C.A., Heitmeyer, J.R., & Grise, K.S. Elementary school-age children and their
clothing: The development of appearance management and perception abilities.
International Textile and Apparel Association Annual Meeting, Minneapolis,
November 1994.
NAHB Research Center
C-35
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A. An international survey of children's symbol- making tools and factors
influencing their selection and use. International Federation of Home Economics
Congress. Hanover, Germany. July 1992.
Readdick, C.A., Goldbeck, S.L., Klein, E.A., & Cartwright, C. Including the child in
parent-teacher conferences. The 58th Annual International Council on
Exceptional Children Convention, Philadelphia, Pennsylvania, April 1980.
Willis, S.L., Goldbeck, S.L., & Readdick, C.A. Assessing children's involvement in a
Piagetian-based classroom. Jean Piaget Society Eighth Annual Symposium,
Philadelphia, May 1978.
INVITED INTERNATIONAL
PRESENTATION
Readdick, C. A. Building a community partnership: The Gwen Cherry Child
Development Center. Universidad Nacionale, Heredia, Costa Rica, June 2000.
NATIONAL REFEREED
PRESENTATIONS
Readdick, C.A. & Hanline, M.F. (under review). Who wants to be an early intervention
specialist?: Student demographics, knowledge, and values. U.S. Department of
Education, Office of Special Education Programs, Project Directors’ Conference,
Washington, DC, July 2008.
Readdick, C.A. & Hanline, M.F. Preparation of highly qualified early intervention
personnel at Florida State University. U.S. Department of Education, Office of
Special Education Programs, Project Directors’ Conference, Washington, DC,
July 2005.
Readdick, C. A. Noise abatement: A necessary first step in early language development
and literacy. National Association for the Education of Young Children, Chicago,
IL, November 2003.
Readdick, C. A. Content and function of children’s social comparison statements as
influenced by incentive, friendship status, age, and gender. Society for Research
in Child Development Biannual Conference, Albuquerque, NM, April 1999.
Hill, E. W., Mullis, R. M., Readdick, C. A., & Walters, C. M. Intergenerational
perceptions of attachment and prosocial behavior. National Council on Family
Relations Annual Conference, Washington, D.C., November 1997.
Walters-Chapman, C.M., Readdick, C.A., Hill, E.W., Mullis, R.L., & Bush, C. Female
adolescents’ perceptions of parental behavior and social support as factors in
parental support. National Council on Family Relations Annual Conference,
Portland, November 1995.
NAHB Research Center
C-36
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C.A., Mullis, A.K., Eldridge, L., Goldbeck, S.L., Klein, E.A, Mize, J. & Fu, V.
The problem of the match: Overcoming cognitive barriers to learning
developmentally appropriate practice. National Association for the Education of
Young Children Annual Conference, Atlanta, November 1994.
Troeger, B.J. & Readdick, C.A. The ART Scale: A measurement for assessing the
artistic merit of children's drawings. National Art Education Association Annual
Conference, Chicago, April 1993.
Bradbard, M.R., Endsley, R.C., Brown, E.G., & Readdick, C.A. How and why parents
select profit-making day care for school-age children: A study of three
communities. National Council on Family Relations Annual Conference,
Orlando, November 1992.
Readdick, C.A. That fat primary pencil: Should we be writing it off? National Association
for the Education of Young Children Annual Conference, Atlanta, November
1989.
Readdick, C.A., & Bartlett, P.M. A Piagetian reconsideration of bulletin boards in the
early childhood classroom: Vertical learning environments for child construction
of knowledge and representation. National Association for the Education of
Young Children Annual Conference, Detroit, November 1981.
Peters, D.L., Klein, E.A., Readdick, C.A., & Goldbeck, S.L. Where to look for the child in
early childhood education. National Association for the Education of Young
Children Annual Conference, New York, November 1978.
REGIONAL REFEREED
PRESENTATIONS
Readdick, C.A. & Douglas, K. More than line leader and door holder: Engaging young
children in real work in the early childhood setting. Southern Early Childhood
Association Annual Conference, Louisville, March 1998.
Readdick, C.A. Little tools for little hands: Selecting crayons, markers, and pencils for
young children. Southern Early Childhood Association Annual Meeting, Orlando,
March 1995.
Readdick, C.A. Social comparison processes in mother-child sibling interaction: Effects
on the child's social competence. Southeastern Psychological Association 22nd
Annual Meeting, New Orleans, March 1976.
Readdick, C.A. Social comparison in maternal sibling interaction: A preliminary report.
Inter-Institutional Conference on Child and Family Development, Athens,
Georgia, November 1975.
NAHB Research Center
C-37
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
STATE REFEREED
PRESENTATIONS
Readdick, C.A. Reducing noise and promoting early language development in early
care and education settings. Early Childhood Conference of Florida, Orlando,
FL, September, October 2004.
Readdick, C. A. & Winegard, N. More it’s in the bag: Single portion cooking with young
children. Early Childhood Conference of Florida, Orlando, Fl, September 2003.
Readdick, C. A. Noise abatement: A missing first step in early literacy programs. Florida
Children’s Forum Leadership Conference, Orlando, FL, November 2002.
Winegard, N. & Readdick, C. A. Developmentally appropriate naptime practices. Early
Childhood Association of Florida Conference, Orlando, September 1998.
Readdick, C.A., Valenza, V. & Winegard, N. It’s in the bag: Single-portion cooking with
young children. Early Childhood Association of Florida Conference, Orlando,
September 1997.
Readdick, C.A. & Park, J. Climbing: Skills and activities for young children. Early
Childhood Association of Florida Conference, Orlando, September, 1996.
Readdick, C. A. The child-parent-teacher conference: A setting for child development.
Florida Association for Childhood Education International Annual Conference,
Tallahassee, March 1989.
STATE INVITED
PRESENTATION
Readdick, C.A. Designing classroom environments. Florida Partnership for School
Readiness Quality Initiative Symposium, Tampa, FL January 2005.
LOCAL REFEREED
PRESENTATIONS
Readdick, C.A., Levy-Tacher, E. & McCants, M. (under review). What can little children
do with modeling clay, play dough, and Model Magic? Seventeenth Annual Early
Childhood Conference, Tallahassee, FL, 2008.
McCants, M. & Readdick, C.A. Celebrations: The ties that bind us together. Sixteenth
Annual Early Childhood Conference, Tallahassee, FL, February 2007.
Readdick, C.A. Talking with young children: The key to reading success. Fourteenth
Annual Early Childhood Conference, Tallahassee, FL, March 2005.
NAHB Research Center
C-38
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Readdick, C. A. & McCants, M. Playmaking: The art and craft of the professional
educaregiver. Twelfth Annual Early Childhood Conference, Tallahassee, March
2003.
Readdick, C. A. & Montford, E.P. Transitions: From terrible to terrific. Twelfth Annual
Early Childhood Conference, Tallahassee, March 2003.
Readdick, C. A. & Montford, E. P. Making pancakes with preschoolers and Piaget.
Eleventh Annual Early Childhood Conference, Tallahassee, March 2002.
Readdick, C. A. & McCants, M. “It’s a beautiful day in the neighborhood”: Finding
friends, making mentors. Eleventh Annual Early Childhood Conference,
Tallahassee, March 2002.
Readdick, C. A. Blowing more bubbles for fun and discovery learning. Tenth Annual
Early Childhood Conference, Tallahassee, March 2001.
Readdick, C. A. & Fritzen, R. S. Nursery rhymes for language and laughter. Ninth
Annual Early Childhood Conference, Tallahassee, March 2000.
Readdick, C. A. & Fritzen, R. S. Ten-minute fieldtrips. Ninth Annual Early Childhood
Conference, Tallahassee, March 2000.
Readdick, C. A. I can blow a bubble! Eighth Annual Early Childhood Conference.
Tallahassee, March 1999.
Readdick, C.A. Letting little children do real work. Seventh Annual Early Childhood
Conference. Tallahassee, April 1998.
Readdick, C.A. and Park, J. Prescription for healthy skin: Helping Florida’s children be
sun safe. Sixth Annual Early Childhood Conference. Tallahassee, March 1997.
Readdick, C.A. The climbing child: What we should know and do. Leon Association for
the Education of Young Children Annual Conference, Tallahassee, April 1996.
Readdick, C.A. Plants for play in children's outdoor environments. Third Annual Early
Childhood Conference, Leon Coalition for Young Children, Tallahassee, May
1994.
Readdick, C.A. More than swinging and sliding: Transforming your playground into an
outdoor classroom. Second Annual Early Childhood Conference, Leon Coalition
for Young Children, Tallahassee, April 1993.
Readdick, C.A. Buttons, blocks, and beads: Basics for fine-motor development,
drawing, and writing. Leon Association for the Education of Young Children,
Tallahassee, April 1989.
NAHB Research Center
C-39
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
INVITED PRESENTATIONS
“Managing young children’s diverse needs for sleep.” Beginning Steps Preschool,
Tallahassee, October 2006.
“All children are special: Make a place in your program for each child.” with Mary Francis
Hanline. Leon Association for the Education of Young Children, Tallahassee,
October 2003.
“Tea cakes, wheelbarrow rides, and long johns: Drawing on our own childhood
experiences to derive best practices for work with young children.” Elder Care
Services, Tallahassee, October 2001.
“Babies are for holding and other bits of wisdom.” Elder Care Services, Tallahassee,
March 2001.
“Social skills building with preschoolers.” Tallahassee Community College Extended
Studies Program, April 2000.
“Dictator or shepherd: Which parent is best for young children?” Annsworth Academy,
Tallahassee, March 2000.
“What to say and do as a volunteer with children.” Kids in the ‘Hood. Tallahassee Parks
and Recreation, August, September 1998.
“Vertical learning environments: Expanding opportunities for learning beyond the table
top.” Tallahassee Community College Extended Studies Program, May 1998.
“It’s in the Bag: Single portion food preparation.” Leon Association for the Education of
Young Children. Tallahassee, January 1998.
“Collecting, hauling, and dumping: Like 2 and growing.” Leon County Early Intervention
Program, Tallahassee, November 1996.
“Developmentally appropriate relationships, activities, and environments in early and
middle childhood.” Bethel Christian Academy, Tallahassee, August 1996.
“Small symbol-making tools for small children: Developmentally appropriate practice.”
Faith Presbyterian Preschool, Tallahassee, January 1996.
"How parents can help their children be creative." Big Bend Community Coordinated
Child Care, Tallahassee, June 1995.
"Looking closely at children: Developing observation and recording skills." Capital Area
Community Action Head Start, Tallahassee, August 1994.
"Paying attention to children: Issues in child development." Restructuring Home
Economics for the 21st Century, College of Human Sciences, Tallahassee,
June 1994.
NAHB Research Center
C-40
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
"Basics for fine motor development, drawing, and writing: Selecting child-sized marking
tools and other manipulatives." Conference on Children, Waycross College,
Waycross, Georgia, February 1994.
"Positive child guidance tips for parents." YMCA Children Playhouse, February 1994.
"Conducting developmentally appropriate field trips with young children." Leon
Association for the Education of Young Children, Tallahassee, November 1993.
"Creating outdoor learning environments." Capital Area Community Action Head Start,
Tallahassee, August 1993.
"Peacemaking in the family." First Presbyterian Church, Tallahassee, February 1993.
"Children's art and writing." Capital Area Community Action Head Start, Tallahassee,
August 1992.
"Six through twelve year olds: Continuity and change." Advent Episcopal Church,
Tallahassee, May 1992.
"Child growth and development: Appropriate teaching practices for your child." Capital
Area Community Action Head Start, Tallahassee, January 1991.
"Developmentally appropriate teaching practices." School Board of Okaloosa County,
Fort Walton Beach, June 1991.
"A descriptive study of toddlers and preschoolers drawing and writing." Florida Home
Economics Association District B, Tallahassee, October 1990.
"Understanding child abuse and neglect." Delta Kappa Gamma Tallahassee, March
1988.
GUEST LECTURES
“Using ethnographic techniques to determine child well-being.” HOE 6931, Proseminar,
Fall 2007.
“Oh, so babies can climb before they walk! and other discoveries.” HOE 6931,
Proseminar, Fall 2006.
“Discovering the competencies of young children through observation.” HOE 6931,
Proseminar, Fall 2005.
“A contemporary view of children and families.” The Family Experience: Deconstruction
and Construction, Museum of Fine Arts, Florida State University, Summer 2006.
“Never underestimate the competence of little children.” HOE 6931, Proseminar, 2004.
NAHB Research Center
C-41
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
“Tailoring the environment, materials, and activities according to the developmental
status and competencies of the individual.” HOE 6931, Proseminar, 2002.
“Applying Science Developmentally: The Gwen Cherry Child Development Center
Community Partnership Project.” HOE 6931, Proseminar, 2000.
“Communicating through print media.” HOE 4054, The Educative Process, 1999.
“Developmentally appropriate practice: Middle school and high school-age contexts.”
CHD 4250, Contexts for Middle Childhood/Adolescent Development, 1999.
“Promoting language development: Birth to age 8.” CHD 4225, Contexts for Early
Childhood Development, 1999.
“Interdisciplinary solutions: Sun protection for young children.” HOE 6938, Proseminar,
1998.
“Working on behalf of children and families in the ‘near’ and ‘far’ environments.” HOE
3050, Development and Trends in Human Sciences, 1997.
"The touch and go of teaching teens." HEE 4941 Student Teaching Seminar, 1996.
“Writing for professional publications.” HOE 6938, Proseminar, 1996.
"Adolescents in Families: Demographic trends and parenting styles." CHD 4240,
Adolescent Development, 1995.
"Hypotheses testing in the field." HOE 6017, Research Methods, 1993.
"Writing for the lay audience." HOE 6917, Research Communications, 1991.
"Writing for the public." HOE 6917, Research Communications, 1991.
"Curiosity and child proofing." CHD 3220, Child Growth and Development, 1990.
"Conducting an observational research project with children." HOE 6017, Research
Methods, 1990.
"Social comparison as a social cognitive mechanism for the construction of self." CHD
6930, Seminar in Child Development, 1990.
"Conducting an observational research study." HOE 6917, Research Methods, 1989.
"An ecological model of adolescent development." CHD 4240, Adolescent
Development, 1989.
NAHB Research Center
C-42
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
COURSES TAUGHT
Florida State University
Child Growth and Development
Child Guidance
Adolescent Development
Adolescent Development and Sexuality
Techniques and Issues in Child Study
Practicum in Child Development: Infancy
Practicum in Child Development: Preschool
Practicum in Child Development: School-Age
Readings in Family and Child Sciences
Contexts of Early Childhood Development
Contexts of School-Age Child and Adolescent Development
Children’s Environments: Design and Measurement
Seminar in Child Development: Child Care Issues and Advocacy
Seminar in Child Development: Child Development Issues
Seminar in Child Development: Globalization and Child Wellbeing
Internship in Child Development
Directed Independent Study
Supervised Teaching
Honors Thesis
Thesis
Dissertation
Special Project
Readings in Child Development
Hood College
Child Development
Creative Learning Experiences
Guiding the Behavior of Young Children
Integrating the Early Childhood Curriculum through the Language Arts
Weber State College
Developmental Planning for Young Children
Working with Parents
Learning with Your Child
Early Childhood Education
Organization and Planning of the Preschool Classroom
NAHB Research Center
C-43
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
ADMINISTRATION
Project Director, Gwen Cherry Child Development Center Community Partnership
Project, 1999-2002.
Acting Director, Child Development Center, The Family Institute, Florida State
University, 1994-2005.
Director, The Sidwell Preschool, Home and Family Life Department, Florida State
University, 1987-1991.
Director, Onica Prall Child Development Center, Education Department. Hood
College,1979-1981.
Director, The Children’s School. School of Education. Weber State College, 1977-1978.
Educational Coordinator, Project Head Start. Ogden, Utah. 1971-1971.
Director, Utah Migrant Council Summer Day Care Center Layton, Utah. 1971.
COMMITTEES
University
Ad Hoc University Smoking Cessation Policy Committee, 2006-present.
University Committee on Faculty Sabbaticals, 2007-2009, 2005-2007, 20032005.
Refund Committee, 1998-2003; 1991-1994.
College of Human Sciences Faculty Senate Alternate, 2006-2008,
1999-2001,1994-1996.
Equal Opportunity Committee, 1991-1992.
Teacher Education Advisory Committee, 1991-1999.
College of Human Sciences, Commencement Marshall, 1993-1996.
Ad Hoc University Child Care Committee, 1994-2004.
College
CHS Dean Search Committee, 2006.
Graduate Faculty Status Committee, 2005-present.
Faculty Advisory Committee, 2000-2006, 1996-1999,1991-1995.
Promotion and Tenure, 1997-2000.
Dean's Advisory Committee, 1990-1991.
Curriculum Committee, 1989-1990.
External Development Task Force, 1993-1994
Ad Hoc Recognition Committee, 1993-1994.
CHS Capital Campaign Undergraduate Scholarships Committee, 1994-1997.
Ad Hoc Committee on Research Perspectives, 1994-1995.
NAHB Research Center
C-44
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Department
Executive Committee, 2006-2007, 2005-2006, 2003-2004, 1995-1999, Chair
1997-1998.
Undergraduate Curriculum Committee, 1995-2003, Chair 1997-1998.
Child Development Curriculum Committee, 1989-1992.
Promotion and Tenure Committee, 1992-1999.
Eminent Scholar Committee, Chairperson, 2000-2002, 1988-1995.
GRADUATE STUDENTS
Major Professor
Dissertation
Hamlin-Glover, D. (in progress). Marriage and Family Therapy.
Levy-Tachter, E. (in progress). Child Development.
Rainey, S. (in progress). Marriage and Family Therapy.
Zahn, S. (in progress). Marriage and Family Therapy.
Marty, A. (2006). Non-parental child care and toddler-mother attachment.
Taliano, K. (2005). Social comparison behavior of young school-age
boys.
Gilbert, P. (2004). Marital satisfaction in forgiving and unforgiving
families.
Saxby, E. (2000). Adolescent community service involvement.
Thackeray, A. (2000). Young children’s relational perceptions of God.
Zeegers, S. (2000). Children’s issues in the Journal of Home
Economics (1909-1994): A content analysis.
Elk, C. (1999). Adolescent perceptions of parental attachment and MDMA
(Ecstasy) use.
Doctoral
Harrington, M. Family Relations.
Keller, K. Family Relations.
NAHB Research Center
C-45
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Master's Thesis
Brock, L. (in progress). Child Development.
Jianhong, R. (2006). Ethnic identity and psychological adjustment of
young adolescents born in China and living in the United States.
Hessel, S. (2004). “Parent and teacher perceptions of schoolagechildren’s multiple intelligences.”
Zhu, Y. (2000). “Grandparenting style, grandparent-parent relationship,
and child social competence among selected Chinese families.”
Olivieri, B. (1999). “Development of movement patterns in climbing: Two
children with Down Syndrome.”
Winegard, N. (1998). “Caregiver, parent, and child perceptions of
naptime.”
Schaller, R. (1998). “Effects of summer camp on self-esteem of schoolage, inner-city children.”
Alexander, L. (1997). “Social support, stress, and coping among mothers
of preschoolers.”
Newland, R. (1997). “Social support and self-esteem in early, middle,
and late adolescent cancer patients.”
Levy-Tachter, E. (1997). “The relationship between creativity and
aggression in selected second graders.”
Dotolo, A. (1997). “The relationship between anatomical knowledge, selfesteem, and self-concept in selected preschool children.”
Park, J. (1997). “Preschoolers’ movement patterns while climbing three
stationary structures: Slopes, stairs, and ladder.”
Purvis, E. (1997). “The relationship between chronological age and
spatial reasoning with puzzlemaking strategies in selected
preschool children.”
Fritzen, R. (1995). "Supersitters: Adolescents caring for siblings and nonsiblings."
Lampkin, C. (1995). "Bedtime rituals and behaviors: Relationship with
young children's social acceptance and social competence."
Gibbs, K.K. (1995). "Self concept and locus of control in children
hospitalized with cancer."
NAHB Research Center
C-46
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Lin, H. (1994). "The relationship between teaching methods and
preschool children's academic achievement and creativity in the
People's Republic of China and in the United States."
McGinnis, M. (1994). "The relationship of physical attractiveness,
teacher-child attachment, and social competence among
preschool children."
Smith, L.T. (1992). "The effects of cooperation, competition, and
friendship on children's communicative competence."
Springsteel, A.M. (1992). "The relationship of young children's physical
developmental history, physical competence, and peer social
acceptance."
Hall, L.S. (1992). "The mother-daughter relationship as context for the
development of daughters' body image, self-esteem, and weight
preoccupation."
Ducar, K.A. (1992). "The relation of caregiver self-perceived roles and
caregiver-child attachments in family day care.”
Ghazvini, A.S. (1992). "Perceived frequency and importance of
communication patterns by caregivers and parents in subsidized,
contracted subsidized, and nonsubsidized child care settings."
Master’s Project
Capley, M. (in progress). Child Development.
Washington, N. (in progress). Family Relations.
Kelley, K. (2001). “Preschoolers’ perceptions of emotion/color
associations.
Lazar, B. (1998). “Environmental education in a Florida sinkhole.”
Senior Honors Thesis
Tracy, C. (1993). "Recycle centers: Promoting hands-on learning in the
classroom."
NAHB Research Center
C-47
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Committee Member
Doctoral
Kang, J.H. Art Education.
Chen, Y.S. Communication.
Hoffman, E. Child Development.
Hueber, J. Child Development.
Kalifeh, P. Educational Leadership.
Lin, M. Early Childhood Education.
Seo, H. Family Relations.
Gentry, E. Marriage and Family Therapy.
Moran, D. Marriage and Family Therapy.
Staier, T. (2007). Marriage and Family Therapy.
McKay, K. (2006). Family Relations.
Darden, F. (2006). Communication Disorders.
Birkin, B. (2004). Child Development.
Staing, T. (2004). Marriage and Family Therapy.
McWey, L. (2002). Marriage and Family Therapy.
Spaniol-Mathews, P. (2001). History.
Parducci, A. (2001). Family Relations.
Gatz, A. (2000). Family Relations.
Yu, Y. (2000). Child Development.
Anderson, D. (2000). Child Development.
Park, J. (2000). Child Development.
Myers, R. (2000). Early Childhood Education.
Fontaine, N. (1997). Early Childhood Education.
NAHB Research Center
C-48
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
Ghazvini, A. S. (1997). Child Development.
Ardley, J. (1997). Early Childhood Education.
Littlejohn-Blake, S.M. (1996). Family Relations.
Willmott, K.E. (1994). Early Childhood Education.
Master's Thesis
Incze, C. (2005). Communication Disorders.
Gordon, D. (2001). Child Development.
Prokos, N. (1998). Child Development.
Lin, Y.L. (1997). Child Development.
Trotter, D. (1997). Family and Consumer Science Education.
Flowers, N. (1997). Child Development.
Knothe, R. (1997). Child Development.
Saxby, E. (1997). Child Development.
Zeegers, S.K. (1994). Home Economics Education.
Boudreau, C. (1992). Child Development.
Tacon, A. (1991). Child Development.
Master's Project
Lauw, C. (2006). Child Development.
Birkin, B. (1999). Child Development.
Pericelli, M. (1998). Child Development.
Hicks, W. (1996). Child Development.
Finley, T. (1996). Child Development.
Bergman, A. (1996). Child Development.
Nalls, K. (1995). Child Development.
NAHB Research Center
C-49
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
McBride, K. (1994). Child Development.
Jones, L. (1992). Child Development.
Smith, J. (1991). Child Development.
Galloway, M. (1991). Child Development.
Senior Honor's Thesis
Lee, N. (2003). Psychology.
Presbylick, E. (1998). Psychology.
Kicklighter, C. (1994). Communication.
Drewes, A. (1991). Psychology.
Weissberg, L. (1990). Psychology.
SERVICE
National
Ad Hoc Reviewer, Traumatology, Russell Sage Publishers, 2007.
Ad Hoc Reviewer, Research on Social Work Practice, Sage Publications, 2006.
Consultant, Binney & Smith, The Crayola Company, Tallahassee, FL,
December 2002.
Member, National Advisory Committee on Early Care and Education, The
Institute for Women’s Policy Research, Washington, DC 2001 – 2005.
Consultant, Binney & Smith, The Crayola Company, Easton, PA, June 2001.
Consultant, Schwartz, Cooper, Greenberger & Krauss, Chicago, IL, August 2001.
Consultant, Binney & Smith, The Crayola Company, Bethlehem, PA, October
1998.
Consultant, Binney & Smith, The Crayola Company, Bethlehem, PA, May 1997.
Participant/Representative for Florida State University, National Summary
Meeting, Stresses on Research and Education at Colleges and
Universities. NSF National Science Board and NAS GovernmentUniversity-Industry Round Table (GUIRR) Washington, D.C.,
December 1993.
Consultant, Binney & Smith, Easton, PA, June 1989.
Consultant, Child Development Advisory Committee, Binney & Smith, The
Crayola Company, New York, April 1989.
NAHB Research Center
C-50
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
State
Steering Committee, Parents’ and Children’s Day, 2003-2006.
Associate, Florida Inter-University Center for Child and Family Studies, 1994present.
Critical Review Committee, 30-Hour Introductory Child Care Training Module,
Child Care and Prevention, Department of Health and Rehabilitative
Services, 1994.
Critical Review Committee, Family Day Care 30-hour Training Module, Child
Care and Prevention, Department of Health and Rehabilitative Services,
1991.
Expert Witness, provided testimony and materials on regulatable features of
quality in child care, including caregiver training, adult child ratio, and
indoor square footage, in support of Child Care Plus Bill, Florida
Legislature, March 1991.
Local
Chair, Tallahassee-Leon County Steering Committee, Parent’ and Children’s Day
2004, 2003.
Board of Directors, School for the Arts and Sciences, Tallahassee, 2005-2008,
2002-2005.
Board of Directors (President 1995-1998), Kids, Inc. (formerly Big Bend
Community Coordinated Child Care), Tallahassee, 1991-2004.
Board of Advisors, Florida State University Alumni Village Child Development
Center, 1993-2004.
Advisory Committee, YMCA Children’s Playhouse, Tallahassee, 1994-1996.
School Advisory Committee, Leon Early Intervention Pre-Kindergarten Program,
Little Chaires School, Tallahassee, 1993-1997.
Faculty Advisor, Alpha Chi Omega Sorority, 1994-2000.
Planning Committee, Faculty Luncheon Series, Presbyterian University Center,
Tallahassee, 1994-1995, 1998-1999, 1999-2000, 2004-2005, 2007-2008.
Family Columnist, Tallahassee Democrat, Tallahassee, March 1995-1999.
Parenting Columnist, Tallahassee Democrat, Tallahassee, March 1986February 1987.
NAHB Research Center
C-51
May 2008
CURRICULUM VITAE: Christine Andersen Readdick
REVIEWER
Textbooks
Adolescence, McGraw-Hill, June 1997.
Adolescence: Continuity, Change, and Diversity, Third Edition, Mayfield
Publishing Company, October 1996.
A Child's World, Seventh Edition, McGraw-Hill, Inc. October 1994.
Adolescence, Third Edition, Harcourt Brace College Publishers, July 1994.
Adolescence, A Contemporary View, Third Edition, Harcourt Brace,
February 1993.
Adolescence, Steps to the Future, Mayfield Publishing Company, April 1989.
NAHB Research Center
C-52
May 2008
CURRICULUM VITAE: Kimberly Elaine Stone
CURRICULUM VITAE
Kimberly Elaine Stone, MD, MPH
Date: December 4, 2007
Contact Information:
Home
4 Woodby Drive
Sunningdale Berkshire
SL5 9RD
United Kingdom
Email: [email protected]
US Mailing Address:
c/o Jeffrey Pearson
Consumer Europe Maidenhead
PO Box 950
New Brunswick, NJ 08903
Education and Training:
Years
Institution
1988-1991
University of Pennsylvania
Philadelphia, Pennsylvania
Degree/Program
Bachelor of Arts
1992-1996
University of Cincinnati
Cincinnati, Ohio
Doctor of Medicine
1996-1999
Children’s Hospital Medical Center
Cincinnati, Ohio
Internship/Residency
Pediatrics
2003-2006
The Johns Hopkins University
School of Medicine
Baltimore, Maryland
Fellow, General Pediatric
Academic Development
2004-2005
Johns Hopkins University
Bloomberg School of Public Health
Baltimore, Maryland
Master of Public Health
NAHB Research Center
C-53
May 2008
CURRICULUM VITAE: Kimberly Elaine Stone
Honors:
1991
University of Pennsylvania
Graduated Magna Cum Laude
1996
1995
1996
1996
University of Cincinnati
Class Valedictorian
Alpha Omega Alpha Honor Society
Carl Wiehl Exellence in Pediatrics Award
American Medical Women Association’s
Outstanding Student Award
Dr. and Mrs. Robert E. Ott Award
Stella Feis Hoffheimer Award
Daughters of the American Revolution
Scholarship
Johns Hopkins University
Delta Omega Honor Society
Injury Certificate
1996
1996
1992-1996
2005
2005
Professional Experience:
1999-2001
Eastgate Pediatrics, Southern Ohio Health Services Network
Pediatrician
Center Director
2001
Columbus Children’s Hospital Pediatric Clinics
Clinical Instructor
2001-2002
Columbus Children’s Hospital Urgent Care
Assistant Professor, Pediatrics
2005-Nov 2007
Greater Baltimore Medical Center
Pediatric Hospitalist and Emergency Care Physician
Sep 2006-Nov 2007 Sheppard Pratt Hospital
Pediatric and Primary Care Consultant
Research Activities:
Peer Reviewed Scientific Articles
Stone KE, Lanphear BP, Pomerantz WJ and Khoury J. Childhood injuries and deaths due
to falls from windows. J Urban Health. 2000;77(1):26-33.
Stone, KE, Burrell, L, Higman, S, McFarlane, E, Fuddy, L, Sia, C and Duggan, AK.
Agreement of injury reporting between primary care medical record and maternal
interview for children age 0-3 years: implications for research and clinical care.
Ambulatory Pediatrics. 2006;6(2):91-95.
NAHB Research Center
C-54
May 2008
CURRICULUM VITAE: Kimberly Elaine Stone
Stone KE, Eastman EM, Gielen AC, Squires B, Hicks G, Kaplin D, Serwint, JR. Home
Safety in Inner Cities: Prevalence and Feasibility of Use in Inner-City Housing.
Pediatrics. 2007;120(2):e1-e346-353.
Published Abstracts
Stone KE, Duggan AK, Burrell L, Sia, C. Can Home Visitation in Early Childhood Reduce
Injuries? Pediatric Research Abstract Issue, 2004 April 55(4): Abstract #1982. Presented at
the Pediatric Academic Societies’ Annual Meeting, May 4, 2004, San Francisco, CA.
Review Articles/Non Peer-Review
Stone, Kimberly E., Lead Screening in Maryland. The Maryland Family Doctor. 2004
41(1):12-13.
Stone, Kimberly E., Home Safety – It’s No Accident. Healthy Start Newsletter. August
2005.
Stone, Kimberly E. and Serwint, Janet R. Otitis Externa. Pediatrics in Review.
2007;28(2):77-78.
Research Presentations
Can Home Visitation in Early Childhood Reduce Injuries? Presented at the Ambulatory
Pediatric Association Region IV Meeting, January 17, 2004.
Can Home Visitation in Early Childhood Reduce Injuries? Presented at the Pediatric
Academic Societies National Meeting, San Francisco, California, May 3, 2004.
Safety in the City: Environmental Appropriatness of Safety Supplies in Low-Income,
Urban Populations, Presented at the Ambulatory Pediatric Association Region IV
Meeting, Charlottesville, VA, January 14, 2006.
Extramural Sponsorship:
Research Support
July 2004-June 2006
Project Title: “Design, Implementation and Evaluation of an Injury Prevention Protocol
in an Established Home Visitation Program”
Funding Agency: Thomas Wilson Sanitarium of Baltimore City
Total Direct Costs: $19,922
Role: Principal Investigator
Training Support
2003-present
5 D14 HP 00118
Faculty Development in Primary Care Award Training Grant
Health Resources and Services Administration, Bureau of Health Professions
(Stipend and Tuition Support)
NAHB Research Center
C-55
May 2008
CURRICULUM VITAE: Kimberly Elaine Stone
Educational Activities:
Clinical Teaching
2000-2001
University of Cincinnati College of Medicine
Preceptor, 1st year medical student Clinical Pediatrics Rotation.
• Provided opportunity for first year medical students to
experience pediatric practice in a private office setting.
2001-2002
Columbus Children’s Hospital
Clinical Instructor
• Supervised residents and medical students 1-2 days per
week
• Attending physician at Case Conference quarterly
2003-present
Harriet Lane Primary Care Clinic
Preceptor
• Provide clinical supervision to pediatric residents and
medical students two ½ days per week.
• Contribute to primary care curriculum design
• Lead weekly small group evidence-based didactic sessions.
• Participate in monthly journal clubs and case conferences.
• Assist with development and implementation of structured
clinical observation tool.
• Lead corporate fund-raising for “Share the Spirit”
campaign, which provides holiday gifts for the clinic’s
neediest families.
Workshops and Presentations
Case Conference Presentation: “The Child Who Refuses to Walk”
Johns Hopkins Children’s Center, October 2003
“Giving Back by Giving Feedback:
Ambulatory Pediatric Association Regional Meeting
Charlottesville, VA, January 14, 2006
“Giving Back by Giving Feedback
Pediatric Academic Societies Workshop Presentation
San Francisco, CA May 2, 2006
Clinical Activities:
Medical Licensure
2003-present
1997-2004
NAHB Research Center
Maryland
Ohio
D0059764
35-07-3530-S(inactive)
C-56
May 2008
CURRICULUM VITAE: Kimberly Elaine Stone
Board Certifications
1999-present
Clinical Certifications
1996-present
November 2001
Diplomate, American Board of Pediatrics
Recertification Completed October 2006
Renewal December 2013
Pediatric Advanced Life Support
Advanced Pediatric Life Support
Clinical Service Responsibilities
2003-2006
Inpatient Fellow for Harriet Lane Clinic
3 weeks per year
2003-2006
Harriet Lane Clinic Preceptor
Two ½ day sessions per week
Professional Societies:
1996-present
1999-present
2001-2002
Fellow, American Academy of Pediatrics
Member, Section on Injury and Poisoning and Prevention
Ohio Chapter Regional Coding Advisor (2001-2002)
2003-2007
Member, Ambulatory Pediatric Association
2004-2005
Member, American Public Health Association
Section on Injury Prevention
NAHB Research Center
C-57
May 2008